Concetta Fierravanti-Wells (NSW, Liberal Party, Shadow Minister for Ageing) Share this | Hansard source

I rise to speak on Senator Bushby's bill, the Health Insurance (Dental Services) Bill 2012 [No. 2.]. At the outset I want to say that Labor has promised so much in this area but has delivered very little. Indeed, it has been the hallmark of various issues which we have canvassed in relation to so-called health reform, and we have seen how that has fallen over completely. In the end, despite all the talk, all we have is a range of new bureaucracies and we do not know what they are doing other than wasting millions of dollars of taxpayer funds. Worse than that, Labor has undermined the only existing Medicare dental scheme simply because it was introduced by Tony Abbott when he was Minister for Health and Ageing. Minister Roxon has systematically undermined just about everything then health minister, Mr Abbott, undertook. Over the last X number of years since this government has been in power it seems that, if Tony Abbott set it up, the government gets rid of it.

The Chronic Disease Dental Scheme, introduced by the coalition government, was an enormous success. It provided $4,250 in Medicare dental benefits over two years for eligible patients with a chronic health condition. Many of the people who have availed themselves of this benefit are older Australians. Over 17 million services have been provided to approximately one million patients since 2007. The Australian Labor Party has repeatedly tried to close down the scheme, not for policy reasons, not because it was not working and was not delivering better dental health to Australians, but for purely political reasons. The Senate has rejected Labor's attempts to close the scheme. Having failed to close the scheme, the Australian Labor Party embarked on another tack which was to go to very great lengths to undermine the scheme. The government established an audit task force in June 2010 after its attempts to close the scheme were rejected by the Senate.

The coalition supports transparency and appropriate audit processes to detect cases of fraud, misuse of taxpayer funds or the provision of inappropriate services. However, what has become very clear is that under this government's audit processes dentists have been found to be noncompliant and action has been pursued against them for minor technical mistakes with paperwork, even against the advice of the people making recommendations in the audit process. Hence the political witch-hunt undertaken by this government to undermine the scheme in an attempt to shut it down.

In most cases dentists have been caught by an audit process which revealed that practitioners provided appropriate services to patients in need, but did not comply simply because of some technical requirement— mostly where general practitioners had organised treatment plans for beneficiaries and quotations for the services prior to the commencement of the treatment. It was not that the dental work was not good; it was the fact that the necessary piece of paper had not been delivered to the general practitioner or to the patient and, as a consequence, the whole amount was sought to be recovered in what was clearly a political exercise and also a revenue raising exercise. It was because of a technicality. That is not fraud. Indeed, it is clear from indications given by the PSR that no dentist has been prosecuted for fraud. Again I reiterate that this is simply a political exercise. Let us remember that in most cases it was the first interaction for these dentists with Medicare. Most of them are in the private practice area and had not dealt with Medicare before. Therefore, there was an issue about information, and this was clearly brought out in the Senate inquiry that was undertaken and acknowledged as part of the evidence that was given. In many cases, dentists attempted to rectify the situation as soon as they became aware of that requirement. Indeed, most dentists, once aware of the issues, immediately sent treatment plans to general practitioners before an audit had even been commenced.

In one circumstance where evidence was given, a dentist had been randomly audited—and we were assured it was random. Once the process had been undertaken as purely an audit, information was collected against this dentist and then it was indicated to this dentist that the matter could be rectified by informative ways with better education. Notwithstanding that, the dentist was pursued for a substantial amount of money and evidence to that effect was given. Investigating compliance officers have in some cases recommended that an educational letter be sent to a dentist and that no further action be taken. Even when this option was recommended by the compliance officer, dentists still received letters of demand for payment of Medicare benefits.

The finance and public administration inquiry undertaken in relation to this issue clearly pointed to instances—and there were plenty of them—where this happened. This goes back to the point I was making earlier that it was purely a political exercise, because accompanying all of this were the media stories—the feed-in to the media—of all this alleged rorting. Having said that, through this process we have seen cases where there has been wrongdoing, and those cases of wrongdoing ought to be properly dealt with. But the reality is that for most of the dentists in this scheme, the most appropriate course of action was simply an educational letter.

What has happened is that dentists have had their reputations ruined. Some are facing bankruptcy. Professional trust—certainly the professional trust in government funded dental schemes—is being destroyed as a result of this process. One questions the government's intentions in relation to its own dental scheme. Quite frankly, having seen what has happened with this scheme, I would be very surprised if dentists in private practice would go anywhere near this area of work.

The other issue is that, when Workforce Australia was asked at estimates to indicate whether there were sufficient dentists to meet the demand, it became very clear in the evidence that was given to us that the government had not even bothered to do an assessment, because there were no figures, no statistics, in relation to the number of dentists working in the public hospital system. So it begs the question that the government is trying to push through a new scheme and it does not even know how many dentists are in the system. But certainly in further evidence that was given, it was very clear that the number of dentists that do work in the public hospital system is not going to be sufficient to meet the demand. So Senator Bushby introduced this private member's bill and the shadow minister for health, Peter Dutton, introduced the same bill in the other place to redress the inequity of the government's application of section 10(2) of the Health Insurance Dental Services Determination 2007.

It was interesting that on 29 May, just two days before the coalition's private member's bill was expected to pass the House without government support, Senator Kim Carr tabled the statement at the Senate community affairs hearings that the government would issue a retrospective determination to remedy the issue. So, after all the huffing and puffing, on the evening of estimates—clearly we were going ask questions in relation to this—departmental officials came along and issued this statement, which I will come to in a moment. After years of inaction by Labor on the inequity, all of a sudden there was this process against dentists. Why was this not an issue before? It was not an issue before because, once the government's proposed scheme was rejected, it went to plan B, which was to undermine the scheme. This government has been inconsistent in relation to its responses.

I now come to the statement on behalf of Minister Kim Carr on 29 May. It is clear that the minister realised the damage that had been done and he was going back on his position and the position of the government when he stated:

It is our view that we need a retrospective change to the Dental Services Determination within the near future that creates greater flexibility about the compliance arrangements, while still protecting important principles of public policy.

This retrospective change to the Determination would bring the compliance arrangements more closely into line with other parts of Medicare, and would allow for a more educative approach to be used by the Department.

That is the indication that has been given, but here we have Senator Bushby's private members bill, which actually goes to redressing the inequity. We have a bill before the Senate; we are considering it; we are doing precisely what the minister is advocating needs to be done. I would call on those opposite to support and pass Senator Bushby's bill, because it does the very thing that Minister Carr is talking about in his statement.

Earlier I mentioned the issue of these so-called technical breaches. I would remind the Senate of evidence given by the Professional Services Review at the Senate Standing Committee on Community Affairs estimates hearing on 30 May. For the record I would like to repeat some of the comments and the evidence given by the PSR, with reference to stories in the media around the dentistry issue. It said:

… I understand they are more to do with strict auditing processes, auditing of paperwork et cetera. That is not the sort of matter that comes to PSR. We have had no formal notification from Medicare, although there has been some suggestion that there may be cases later this year. But we have had no formal indication from Medicare that they are referring a dentist to us for inappropriate practice which goes beyond, as I understand it, the sorts issues that have been in the media lately. As I said, they are more to do with auditing. Inappropriate practice in terms of the actual professional decisions being made by a dentist, which would be the type of matter that would be referred to PSR—we have not had any referrals and no formal notification.

For all this hype, all this talk, about the so-called rorting of the system, there does not seem to be a correlation between the assertions that have been made by the government and the evidence of the Professional Services Review, which looks at cases of inappropriate practice. No-one was complaining about the quality of the work of the dentists and no-one was questioning that the work was not done properly, but the fact is that as a consequence of lack of proper education there were technical oversights, which in most cases the dentists had sought to clarify. Because the government was on a vendetta against this scheme, it is very clear that they have chosen to pursue this road rather than a much more effective method of approach—the educative letter. It is ultimately what the minister is going to do, but in the interim we have had dentists who have had not only the financial implications of the government's undertaking but also the emotional implications and professional implications for their practises.

Let us do a snapshot of the scheme. There have been almost a million referrals and the average cost of treatment was $1,700. There were 17 million services provided by 12,000 dental practitioners. There are approximately 500 audits underway of which only about a hundred have been completed and in which 66 dentists have been found to be noncompliant. That is for a total outlay of $21 million. This information was provided at a Senate inquiry on 1 May and Senate estimates on 29 May.

In addition to undermining the existing successful Medicare dental program, Labor has also failed to deliver on its own dental program. Labor proposed the Commonwealth Dental Health Program, a program which promised one million services by providing funding to the states and territories. The Commonwealth did not assess the capacity of the public dental workforce, as I indicated earlier, to provide the services and the number of services provided would have been significantly fewer than that promised. Irrespective, it would not have come close to matching the 17 million services that have been provided under the Chronic Disease Dental Scheme. Those opposite never delivered their much promised Commonwealth Dental Health program and it was finally scrapped in the 2012 budget.

Let us also look at the Teen Dental Health plan, introduced in 2008, which provides a voucher indexed for eligible teenagers—that is, households receiving benefits such as Abstudy, a carer payment, the Disability Support Pension, parenting payments, special benefits or youth allowance. This is only to provide preventative checks. The Australian Dental Association argued that the scheme provides no follow-up care for those with dental issues and is too narrow in focus. It is only for 12- to 17-year olds. The low uptake—only 429,000 services forecast for 2011 out of an eligible 1.3 million teenagers—points to another failure. So much for the rhetoric of making dental health a priority with only $60 million in new funding announced this budget. More promises— (Time expired)