David Bushby (Tasmania, Liberal Party) Share this | Link to this | Hansard source

I rise today to speak on the Health Insurance (Dental Services) Bill 2012. This is a bill that I have introduced into the Senate to redress an injustice that the government has inflicted upon the nation's dental health professionals. This bill requires the Minister for Health, in conjunction with others ministers as may be necessary, to redress past and future inequities that have arisen from the operation of subsection 10(2) of the Health Insurance (Dental Services) Determination 2007. The bill describes the inequities imposed on dental practitioners by the operation of the subsection of the determination and specifies five courses of action the minister can take to redress those inequities. It establishes a timeframe in which action is to be taken and requires a report to be tabled in both Houses of parliament detailing the actions that have been taken.

The Medicare Chronic Disease Dental Scheme was introduced by the coalition in government in 2007 and has been a highly successful scheme in addressing the chronic dental needs of countless Australians. It provided and still provides up to $4,250 in Medicare dental benefits over two years for eligible patients with a chronic health condition. Over 17 million badly needed services have been provided to approximately one million patients since 2007. These services, which have greatly improved the overall health of the recipient patients, are ones that, in the majority of cases, the patients would not have been able to privately fund themselves.

But I do not stand in this chamber today to espouse the virtues of this scheme; those virtues are self-explanatory. Instead, I rise to highlight to this chamber the Machiavellian tactics used by the Labor government to try to close down this worthwhile dental program.    Labor have repeatedly tried to shut down this scheme for their own political purposes. Those on the other side of the chamber cannot bear it that the coalition is the only political party in this place to demonstrate and actually deliver on a commitment to a Medicare dental scheme. As they have shown us on many occasions, they are more than happy to forgo good policy outcomes for their own political gain. They particularly hate the fact that this scheme, supporting patients right across Australia to have their chronic dental issues addressed, was introduced by Mr Tony Abbott.

Not able to respect the decision of the Senate when their attempts to close the scheme were rejected, Labor commenced an underhand crusade to undermine the scheme with the establishment of an audit taskforce in June 2010. The coalition strongly supports a transparent and appropriate audit process to detect cases of fraud, the misuse of taxpayer's funds or the provision of inappropriate services. But we do not support Labor's tactic of using innocent and inadvertent administrative errors as a means to claw back funds from dentists, presumably to assist the government in their unattainable quest to achieve a budget surplus—something they have not done for over 20 years!

Upon commencing the audit process, officers from Medicare identified that many dentists had failed to comply with section 10 requirements of the scheme. Under section 10, dental practitioners were required to provide the patient's referring general practitioner with a dental treatment plan prior to undertaking any work on the patient. However, primarily due to a lack of education on those requirements, many dentists were unaware of their administrative obligations and commenced treatment on the first appointment with a new patient prior to providing the necessary paper work to the GP. Treating the oral health needs of a patient prior to fulfilling the administrative requirements of the scheme does not constitute fraud.

In the very common case just mentioned, the timing of the completion of paper work has no impact on patient care or financial outcomes. In the overwhelming majority of cases, the dentists who were caught by the audit process had provided legitimate care to patients in need, entirely in accordance with the terms of the scheme, but for minor and incidental technical requirements of the paper work they were pulled up. Additionally, many dentists worked quickly to rectify their noncompliance as soon as they realised that they were not compliant. Investigating Medicare compliance officers have in some cases recommended that an educational letter be sent to the dentist with no further action taken. But even in those circumstances dentists have still received demands from Medicare for repayments.

This is the case with Tasmanian dentist Wilma Johnson. The case of Dr Johnson was in fact what first peaked my interest in this scheme and the approach the government have been taking to it. Senator Eric Abetz and I have been working very closely with Dr Johnson ever since to try to resolve these issues. Dr Johnson first contacted me last year after she received a demand letter for over $24,000. Initially approached by Medicare for what was termed 'information gathering purposes', Dr Johnson wilfully cooperated, particularly as she was told by Medicare officials that it was nothing more than a 'PR exercise'. When Medicare officials determined that she had been noncompliant in relation to section 10 they immediately began an audit of her previous two years of practice.

Dr Johnson is a highly regarded dental practitioner who is more motivated to work for the public benefit than for her own financial reward. She often works under various programs targeted at improving the oral health of people of low socioeconomic status or with limited access to adequate dental care. At the time she was audited for her work under the Chronic Disease Dental Scheme, she was operating out of what is essentially a rural practice in the Huon Valley region in Tasmania. The Huon Valley has a significant low socioeconomic population, and it is notoriously difficult to attract health professionals of any kind, but especially dentists, to this region.

Additionally, she delivered the services as a part-time employee dentist at this practice and, because she was billed directly the full amount involved, the $24,000—the full amount that was paid under the CDDS—she has been ordered to pay back is three times the amount that she actually received as an employed dentist. Understandably, this situation has proved to be extremely stressful for Dr Johnson. The substantial debt hanging over her head, in addition to her reputation being called into question, has caused her to suffer undue amounts of anxiety and stress and is of great concern to her.

In submissions to the inquiry many other dentists have outlined their frustration with the chaotic manner in which their audits were undertaken. Dentists were sent a letter demanding the provision of 20 files to Medicare within a tight timeframe, but then experienced long delays, often in excess of 12 months, before receiving any response or advice on the outcome of their audit.    One submission from a dentist claims that Medicare found the result of his initial audit of 20 patients to be inconclusive and therefore requested an audit of 700 files. One cannot even begin to fathom why Medicare deemed it necessary to audit a whopping 680 additional files in this instance. But we can only conclude that the resources required for that practice to provide the department with the requested information would have proven to be a significant administrative burden and essentially got in the way of the job of treating patients. Other dentists have complained that Medicare was largely inconsistent in its advice to the profession when inquiries were made. Dentists submitted to the committee that, often, two separate phone calls to Medicare in relation to what they needed to do to comply with the administrative requirements of the scheme would result in two different sets of advice, with many dentists even claiming that Medicare had told them directly that they were not required to do anything other than call Medicare to check on a patient's eligibility for the scheme.

It has been suggested—and not convincingly rebutted by the department or the government—that upon winning the 2007 election, at which time the scheme had only just commenced, Labor decided not to take any of the normal steps to ensure dentists were properly educated in what to do to comply with the administrative requirements, such as training front-line staff to teach dentists, as they intended to close the scheme down as soon as possible and so determined that that education would be redundant. Now, 4½ years later, the scheme is still running. For the first few years, dentists were largely flying blind on admin requirements because the government did not do what was necessary to properly train and educate them in these.

To then use the extraordinarily high level of noncompliance with these minor technical administrative requirements to seek to undermine the scheme and, in the process, vilify good dentists, is appalling. It is not surprising that Dr Johnson and many of her colleagues have withdrawn from the scheme, resulting in diminished access to quality dental care for the hundreds of thousands of patients who sought dental treatment under the provisions of this program. Of course, this is just the outcome that Labor was looking for.

Dr John Wilkins, a GP in Huonville in Tasmania, where Dr Johnson practised, wrote in a submission to the committee inquiry:

The dentists who have accepted my referrals have the reputation for kindness and humanity, care for the underprivileged and putting the needs of the needy ahead of the rest. The punitive outcomes of participation in this scheme has damaged dentist who deserve medals, not mental anguish.

Because of the negative outcomes from this outrageous Medicare backlash … I am now unable to access adequate dental care for many of my most severely compromised patients. This is a disaster.

As that submission highlights, it is the patients who are now suffering as a result of this government's desperate cash grab, because this program largely assists the types of individuals who would ordinarily fall through the cracks.

Labor might not like to admit it, but this scheme has given almost a million people a new lease on life through improved dental care, with some people obtaining the best and most comprehensive dental treatment they have ever received in their lives. In some cases, the dentists were first to admit that they faced serious and at times unpleasant challenges by opening their doors and undertaking this community service, at a reduced rate, for less than the fee payable under the scheme, so that those people who for a variety of reasons found themselves in dire need of oral healthcare treatment could get that treatment.

Across the country, 12,000 dental service providers agreed to participate in the program. Yet, now, my office receives regular phone calls from disgruntled and concerned community groups and constituents who have discovered that their dentist has ceased to operate under the program. This has left many thousands of patients across the country stranded. Many may be halfway through their treatment program, only to discover that their dentist will not be able to complete the dental work they require because they no longer feel safe operating under the scheme.

Dr Johnson tells me that, since she has withdrawn from the scheme, she is extremely limited in the services she can offer her chronic disease dental patients. She has provided me with photos of patients on her books in their mid- to late-20s who have had to have all of their teeth extracted. Under the chronic disease dental scheme, Dr Johnson would have been able to extract the rotten teeth and provide the patients with dentures but, now, all she can do is extract their teeth, at a heavily discounted rate, and send them to the state government run dental service, where it is likely they will endure at least a 12-month waiting list to receive dentures. So they have to spend that waiting time without teeth. I do not think anyone on either side of this chamber would have even contemplated being forced into such a situation during their twenties, or in fact at any other time in their life. The impact of this on patients' mental and physical health is significant. This is the consequence of Labor's money grab from the dentists participating in the scheme.

Over 400 submissions were made to the Finance and Public Administration Committee inquiry into this bill and, let me tell you, they paint a very bleak picture. The government would have us believe that the submissions were all from corrupt and greedy dentists. To the contrary, the submissions were from a range of people in the community. The committee received submissions from administrative staff working in dental practices concerned about the impact the audit process was having on workplace morale and the very real possibility that they might lose their jobs. Many patients who had been treated under the program also wrote submissions in praise of the treatment that they had received and of their concern in relation to the penalties the dentists who provided their treatment now face. One patient wrote:

Dr. Mustafa has provided me with strategies to improve my overall dental health associated with diabetes. I might add here that if such dental treatment wasn't carried out, I and thousands of other people in similar situations would become a huge burden on government resources. We should give credit and thank such care providing professionals rather than penalizing them for possible minor administrative errors.

There are submissions from the spouses of dentists, airing their concerns in relation to the mental health and wellbeing of their partners, who in many cases have suffered undue stress as a result of this audit process. They wrote of the detrimental impact this is having on their home and family life. One such submission, from Mrs Marina Donnellan, the practice manager for her husband's dental practice, read:

He did not do anything to deserve this situation and those people driving this unjust witch-hunt should be ashamed of themselves. It is a smear on the face of our Government.

I am worried about the implications all this will have on my family. If our business suffers the damage will be far reaching affecting my children, our employees, our business associates and their families.

So far-reaching is the impact on these dentists that extended family members of dentists were also compelled to write submissions. One father of a dentist wrote:

It is very severe punishment to reclaim back money for services that have been provided, without consideration for the hard work that has gone into it. It also overlooks the expenditure involved in providing these services, which are high out of pocket expenses.

… … …

It is a tragedy that the government can impose such measures on hard-working professionals, especially in a country like Australia, which supposedly prides itself in being a democratic and just country.

After working so hard to provide dental services to a needy population, he has been made to feel like a criminal and a scapegoat for a political money retrieval system.

And of course there were a huge number of submissions from dentists outlining their frustration and anguish over the unjust auditing process they were subjected to by this government. Dr Susan Ravida wrote:

I feel like Medicare has set a trap for me to provide treatment for free in their name. I think it is common sense that if I provide a service, I deserve to get payment for that service. I did not cheat the system or do anything wrong.

Another dentist said:

Medicare did not reply to my 20 patient self assessment submission for over one year. I received a phone call from Medicare on the 16th February 2012. This left me for one whole year feeling apprehensive, stressed, worried and completely uncertain as to what was going on.

That was Dr Angy Yoannidis. Dr Craig Swift said:

I believe it is important to differentiate the treatment of dentists who have abused the system from dentists who have committed minor administrative oversights. There is a big difference between dentists who have acted dishonestly for their own financial gain, and those who have acted in good faith for their patients' well being. This difference should be reflected in any penalties imposed.

The quotes I read to you today are real quotes from the submissions of real people whose lives have been turned upside down as a result of this government's disgraceful witch-hunt. This government has wrongfully called into question the reputations of hundreds of dentists across the country over a number of years.

Finally last month Minister Kim was effectively shamed into a backflip after months of pressure from the coalition—

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

Madam Acting Deputy President, I rise on a point of a order. I draw to the attention of the senator that it would be useful if he named the minister correctly in his speech. Just check the Hansard. He actually did not name him.

David Bushby (Tasmania, Liberal Party) Share this | Link to this | Hansard source

Minister Kim Carr.

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

You did not say 'Carr'.

David Bushby (Tasmania, Liberal Party) Share this | Link to this | Hansard source

Finally last month Minister Kim Carr was effectively shamed into a backflip after months of pressure from the coalition and the Greens—and I acknowledge that Senator Di Natale, who will be speaking after me, has also taken up the injustice behind these demands. It took every play on the field—numerous media releases, press conferences, letters to the minister, questions at estimates, questions on notice, an inquiry and this private member's bill—for this government to finally concede that retrospective changes are required to the legislation and that maybe some of the dentists involved are being treated unfairly.

And how did Minister Carr decide to make this announcement? After years of tension between government and the dental sector, after years of stress, anxiety and worry placed on dental professionals, Minister Carr decided to announce his backflip in a statement tabled to the Community Affairs Legislation Committee at budget estimates last month, so that affected dentists and stakeholders could read the news in the Age, the Sydney Morning Herald or even the Hobart Mercury over their breakfast the next day.

I will take the opportunity to add here that the announcement was neither gracious nor sincere, with accusations from Minister Kim Carr still flying throughout the estimates period in relation to alleged fraudulent activity undertaken by dentists. It is a totally and utterly disgraceful way for this government to treat a profession that has already been deliberately vilified to suit Labor's own political ends, and it leaves Minister Kim Carr, Minister Roxon and Minister Plibersek with egg on their faces.

Minister Carr has been surprisingly quiet since his May announcement, which is disappointing, because in the wake of the announcement a few weeks ago I spoke to a number of dentists with whom I have been working on this issue, and for the first time in my dealings with them they sounded optimistic and hopeful, like a huge weight had been lifted off their shoulders. I hope that sense of relief is not misguided, because yet again this government has failed to act. We have not heard or seen anything to suggest that it is willing to act quickly to rectify the legitimate concerns of the dental profession.

The dental profession is highly educated and well respected, and yet over 60 per cent of those dentists who have been audited were found to be noncompliant with the admin requirements for the first few years of the scheme. The government maintains that the education provided was sufficient and that dentists were properly informed of the requirements. If it is right, what explanation is there for the extraordinarily high level of noncompliance? I reject the notion that the dentists were not up to understanding the requirements; they are clearly intelligent people. I reject the notion that 60 per cent of participating dentists wilfully ignored the requirements; the percentage is too high for what is generally regarded as a highly honest and very professional group of people.

So what other explanation is there? I cannot think of one, and that brings me back to the assertion by the department that dentists were properly educated and trained on how to use the scheme and the compliance requirements. The only possible conclusion I can draw from the high levels of noncompliance within this program is a failure by the government to adequately educate the profession—and do not forget that dentists are not like doctors, who regularly interact with Medicare. Prior to this scheme, dentists had no relationship with Medicare; the closest was a scheme designed to help veterans, and the requirements of that scheme imposed nothing like the obligations that dentists now have to comply with under the CDDS. In essence, I think dentists have been the meat in the sandwich, and this bill is designed to relieve the pressure that has been unfairly placed upon them.

Claire Moore (Queensland, Australian Labor Party) Share this | Link to this | Hansard source

It is quite distressing to hear the comments made by Senator Bushby this morning in speaking to his private member's bill, the Health Insurance (Dental Services) Bill 2012 [No. 2], and in beginning his whole statement by trying to make this into a political exercise. I was particularly interested in his use of the term 'machiavellian'. There was an open statement by our government from the very start that the scheme we are discussing today was one with which we disagreed. There was no lack of transparency. We argued from the start that this dental scheme would not meet the requirements of the Australian community. You can go back to Hansard and read that. To pretend in this place that the methodology that our government has used—both in opposition in 2007 and since that time—to raise our genuine concerns about the way this scheme operated has been to attack a profession which we hold in great regard is not only inappropriate; it is dangerous, because it means that there is no longer any attempt from either side of the chamber to acknowledge that we need to work effectively and with professional trust with a very strong group of professionals in our community, the dental profession. Senator Bushby's statements and private member's bill are trying to continue the politicisation of a clear disagreement about the way dental schemes should operate in the country.

When we look at the outpourings that we have had about the operation of the Medicare audit process, dentists have been treated in no different way to other professions who are using the Medicare system. There are clear requirements on people in any profession about what they need to do before they can access Medicare payments. That operates for professionals using the scheme and it operates for—a new term we use a lot in the Department of Human Services—citizens who are accessing the scheme. You need to know the process which you are entering and you need to know what your responsibilities are and then you need to work through it all. It is not onerous.

When this particular scheme was introduced very quickly to the Australian public in 2007, a process was put in place at that time to educate the people in this place—and I well remember the debate in this place when that particular piece of legislation came through. There was also a process used to educate the community in the beginning, in 2007, widely publicising this new program that was going to come in. I do accept Senator Bushby's statement that the Liberal and National parties claimed to be the only government to provide access to an effective Medicare system for dental services because they told us that in this place in 2007 and they also told the community that when they were promoting this scheme to everybody. They told everybody what you had to do to access the scheme, which was not income tested—a point that we raised at the time. They said anybody who wanted to access this scheme had to be aware of their chronic disease situation, they had to work with their GP and they had to work with their dentist. The process was that the person who wanted to access dental services would need to work with their doctor—clearly a GP in most cases—and their chronic disease situation would have to be clearly identified. Then, only after that step had been taken, would they move through to their dental practitioner, also under the specific requirement that they would understand the chronic disease aspects of the patient and work with that patient on what treatment would be undertaken and what would be the real cost of that treatment. I well remember that the process was clearly focused on understanding your rights in a chronic disease situation, which was identified in the legislation—and all this was sent out to people across the community—and then you would see what the cost was going to be and what changes would happen.

When we were debating this at that time there were many statements made about the fact that we thought that some people would benefit from the scheme. We did not say that no-one would benefit. I remember also that one of the things that I most celebrated was that there would be the requirement to have a written quote given to the patient before they undertook the treatment so that they would know how much it was going to cost—something that people on this side and, to be fair, people on the other side of the chamber, had argued over many years for: having informed consent before you undertake any form of medical or dental practice. So the requirements for everybody were set out. There were those for the patient, the citizen, who was going to undertake the treatment and the referring GP, because the government continued to be concerned about how we would actually ensure that the intent of the then scheme would actually be maintained so that it would be linked specifically to dental treatment that would be linked to chronic disease. How it would operate was quite narrowly defined. There were those for the dentist, who for the first time was going to access Medicare.

Dentists was told what their responsibilities were. As a very well-educated and strongly advocating profession—we all know that dentists have been advocating for many years that they should have access to Medicare services—there was no ignorance of the Medicare system. In fact, dentists clearly understood how it worked and they had come to many inquiries to talk about how they should be able to access Medicare. So they had their responsibilities set out and, as I repeat, these were not onerous. In fact, they were commonsense ones. They had to ensure that the patients and the doctors would know what work was being done. So if I were going to have work done I would know exactly what work was going to be done and why and, as a patient, I would have in writing a quote about how much it was going to cost. It does not seem to me to be too onerous a requirement that a professional working with a patient would understand that responsibility and, in particular, the core element of the program, as described to this chamber in 2007, which was about this special link between the referring doctor and the dentist so that everybody knew what work was being done and how it would operate. That is how the scheme started in 2007. The dental profession then had access to Medicare, the doctors continued with that access to Medicare and patients across our community were then having this service that was actually being promoted so strongly by the previous government as to what would be the benefits.

So once you have access to Medicare, no matter which part of the system you are in—the patient, the doctor or the dentist—there are responsibilities because this is a government taxpayer-funded scheme. As we know, consistently in this place, at a number of levels, we actually scrutinise the use of Commonwealth funds to see that they are used effectively and to ensure that people are working effectively and legally within the system. There is a general agreement that people should understand their rights, that they should practise within those rights and that they would understand where they operate.

Now what has happened over the period of time has been that people within the dental profession have been exposed as not effectively using their Medicare entitlements and not fulfilling the requirements of the scheme. That does not mean that everybody is undertaking criminal activity. That does not mean that they are labelled in any way and that certainly does not mean—as has been put forward by Senator Bushby and other members on the other side of the house in an attempt to politicise again what should be an open process, one which has operated since Medicare started—that people who are working in Medicare or members of the government or, in fact, the wider community, are labelling or condemning dentists in any particular or general or personal way as being criminal. Again, I think it is important to note that what we are talking about is the integrity and the trust that the community has in the Medicare system. No individual profession, individual practitioner or in fact individual patient should be treated differently. There should be a clear understanding about how the system operates, how people should be assessed and communication should operate on the basis that there are rules, that people need to have those rules understood, that those rules are actually scrutinised from time to time and everybody knows where they fit.

I think it is fair to say that in this program there have been some misunderstandings. No-one pretends that every person who has actually had an audit under the particular dental scheme should be presumed to have either acted in a criminal way or in any sense not understood their rights. Each individual case should be looked at in exactly that way, individually, which is in fact how the audit system operates. There is not a general assessment, there is not a general statement—individual patient files are taken by the Medicare inspectors and looked at and there is a discussion process between the Medicare officers and the practitioner. One point I do accept, and we have discussed this many times in this place, is that sometimes the process takes too long. I accept that from the time the original communication was made with the practitioner the audit process should operate in as quick a time as possible for everyone, so that the individual assessment is done and people understand the reasons on which a decision is made.

There has been quite a degree of effective lobbying. As I said before, the dental profession are extremely effective lobbyists and they have been for many years. On that basis they are well regarded and respected. There have also been some issues within this place at different times with the Senate estimates process and also through lobbying from across the chambers; no individual person has lobbied more strongly or more effectively. In fact, on 29 May in the Community Affairs Senate estimates process, and I am quite pleased to say that many of us were actually at that Community Affairs inquiry, Minister Carr announced that they were going to reconsider the process around the audits of this dental scheme. I think that is an entirely appropriate way to operate to respond to the concerns that have been raised—to look at some of the issues that were raised in the Senate Finance and Public Administration Committee, where there were genuine issues raised by people who claimed they did not understand what was going on. I think that is fair, and it does not matter whether you are a dentist or a medical practitioner or a nurse or from other areas that have recently received Medicare coverage, there is an important responsibility that people need to understand the system, they need to have their own responsibilities clarified, and that everyone in the process must have a genuine understanding of what is going on and their own responsibilities.

Minister Carr has announced that, as a result of the process that had gone on, the department is going to reconsider the area around the audits. They are going to go back and have a look at some of the decisions that had been made. Each individual case will be considered. We do not accept that there has been a general attack on the dental profession. We do not believe that we have stigmatised dentists in this process. There will be some practitioners who have misused the system and we do not pretend that this review that Senator Carr has put in place will automatically write off what has occurred. That does seem to me the intent of the Bushby bill: that there will be an automatic acceptance that any dentist who has had an audit that resulted in a negative response and has had a debt accrue will have their debt written off. I do not think that is fair and I do not think that is in the true sense of the Medicare process. In that case we reject the Bushby proposition in this bill.

We also think it is difficult to start changing the way regulations operate to have the Minister for Health and Ageing being able to write off payment, which is not under the current regulations and creates more confusion and—dare I say it, since we have these discussions every day in this place—could actually create more red tape, which would be an awful thing to happen in terms of more bureaucracy taking place. So for that recommendation in this particular bill, that is not the most effective way to operate.

I think it is important that when people have concerns about our system those concerns are able to be discussed openly. I also think that the dental profession should be able to have that open and professional discussion with the departments, with Medicare and also with the minister. I believe that is occurring. Over this whole process, Senator Bushby has accused the government of making it political. I think that certain elements—and I would hesitate to say it is the opposition—have made an attempt to politicise this process as well.

The system is not, we believe, the best way to operate dental services. The system has in fact benefited some Australians; no-one doubts that. We do not believe that dentists should have special treatment under the Medicare system. They are like any other professional that operates within the system. We also believe that people need to have confidence in the system and that if they truly believe that the audit has not worked effectively for them, or if there is some element in the education process that did not work for them, they should be able to work effectively with the government through the Medicare process to have that heard in an open way, but not necessarily agreeing that debts will be waived.

I am saddened that in this debate about various dental schemes we—and I say we on both sides of the chamber—have caused distress to some people in the community who are still crying out for improved dental schemes. The stories we have heard, that dentists have withdrawn their services because they have been so traumatised by the audit process, are very worrying because the role of a medical practitioner of any kind, including a dental practitioner, is to provide services to those patients who come to them seeking their services. So I am quite saddened that people claim that members of the community now are not going to be able to receive dental processes. I know that other people in this debate will talk about the significant investment that the Labor government has put into dental services in this community and I do not think there is anyone in this parliament who is unaware of the desperate need for effective dental services across the community. Our government has a number of proposals to respond to that. Also, we have been pushing to have alternative dental processes put through the parliament.

But on the particular Bushby bill—we should be discussing the bill before us—we do not think it responds effectively to the issues that have been raised. The Senate Finance and Public Administration Committee heard from dentists who felt they had been poorly treated, as well as from their families and from their staff members—again, an extraordinarily effective form of advocacy. The response from the government is that we have listened and there will be consideration again of the audit process in that area. However, from this point forward, should this particular scheme continue to be in place and, again to be completely transparent, the government wishes to end the scheme and put in place another scheme.

No-one can claim ignorance of the process. The quite standard expectations of medical practitioners, including dentists, are to be up-front with their clients, to talk about the actual processes and treatments and to be clear about how much it is going to cost. No-one can claim ignorance from this point forward about the responsibilities of the profession working within this scheme. In fact, for several years no-one could claim ignorance of the process. If there is a claim around ignorance of the responsibilities, it must be for a very short period of time, because in terms of when people started this process and continued to operate within this scheme, surely there was a time when the clear understanding cut through. We are looking at the claims of particular people in the profession. They must have faith that they will be listened to.

As for the argument in the Bushby bill that there was complete ignorance in the dental profession of their responsibilities, I reject that. I reject also the premise that we have demonised the dental profession or treated individual dentists without respect. I reject that. I also reject the proposals in the Bushby bill around the methodology of wiping out the debt. I do not think it is an effective way of doing it. I also disagree with the way the bill treats the issue of the act of grace payment; it is not an accurate representation of how such a payment should operate within the financial system. The current situation is this: the minister has announced a process for dealing with the concerns and the Medicare audit process will continue for dental and any other medical practitioners in the system. We as a government continue to be completely committed to the need to respond effectively to the community with better, more targeted and effective dental assistance.

Richard Di Natale (Victoria, Australian Greens) Share this | Link to this | Hansard source

Over the past year I have made reforming the nation's dental health system one of my top priorities as a senator, and in fact my party has made it one of its clear priorities. In our agreement to support the Labor Party in government, the Australian Greens made sure that dental health was a significant part of that agreement, Why did we do it? We did it because there is an enormous need in this country to reform our dental system. As a wealthy country, we have poor oral health relative to our wealth. Cost is a huge barrier to treatment. There is not just an enormous health cost associated with this, but there is also an enormous social cost. The Chronic Disease Dental Scheme was implemented because we know there is an association between poor oral health and chronic disease. We know that poor oral health is associated with greater rates of infection, malnutrition and so on.

As I have said, it is not just a health issue; it is a social issue. People who are missing their teeth and are waiting for dentures, often for many years, on public dental waiting lists are less likely to get a job. Imagine sitting in front of a prospective employer missing your front teeth; you are automatically behind the eight ball. The same applies to people who are looking for a property in the rental market. Real estate agents are more likely to make a value judgment about you if you are missing your teeth. That is a fact and it is why this is one of the great reform challenges that faces this nation. It is right up there with other important reforms like the National Disability Insurance Scheme. In my view, it will be one of the greatest reforms since the introduction of Medicare.

Shortly after taking my seat in the Senate, I was approached by a number of dentists who were being audited through the Medicare Chronic Disease Dental Scheme. Despite being a health professional, I did not know much about the scheme—it was not a scheme I had a lot to do with—but the more I learnt about the situation and the more I met dentists who were having similar issues or were in similar circumstances, the more I became convinced that something was seriously wrong.

The Chronic Disease Dental Scheme was the first step for most dentists into Medicare, and I think we need to explain how that scheme works. It was introduced by the Howard government. It is a scheme that essentially says that if you have a chronic disease, you see your GP, your GP can make a referral to a dentist and you are entitled to about $4,200 worth of treatment over a couple of years. There have been criticisms of the scheme and I will talk about those shortly, but the scheme also has benefits. Firstly, we are getting an enormous public investment into dental care, and that is a good thing. Having public money invested in dental care is a good thing. Eighty per cent of people who access the scheme have concession cards. While there is a legitimate criticism around the notion that high-income earners might access treatment, let us be clear that the vast majority of people accessing this scheme hold concession cards—80 per cent—and that is because there is an association between chronic disease and income.

One of the legitimate criticisms of the scheme is that some—a minority—high-income earners are entitled to treatment at the expense of other people who may need treatment but cannot afford it. There is also a question of the scope of service offered through the scheme and should we be providing high-end services to some people, rather than providing a broader range of services to more people and providing good preventative dental care. That is a legitimate criticism. What became apparent as I spoke to dental practitioners who have participated in the scheme was that it was the first time they had been involved in a Medicare scheme; they had very little knowledge of how Medicare worked; and their entry into Medicare was very poorly managed. The rest of us in the medical profession are very familiar with Medicare—we have been working in it for many years—but that is not true of dentists and dental prostheses. In circumstances where you have a new group entering into a Medicare scheme, the department has a huge responsibility to make sure it is managed properly. In our view that was not done. The information that was disseminated to dentists was not done properly. We have had a number of inquiries into the matter, and it is very clear to me that, while some of this information was communicated, it was not communicated as effectively as it should have been.

Medicare is a very complex beast. Even medical doctors often find themselves in trouble because of the complexity with the scheme. It is why we have a professional services review board. In this case, we have to remember that a number of requirements were placed on dentists that are not expected of GPs. It is my firm belief that many of the dentists who took part in the scheme—in fact, the vast majority—acted in good faith to deliver services to people who were eligible for those services and in urgent need of those services, but they fell foul of some of the administrative requirements under the scheme.

I also think it is unfair that we have practitioners who were required to repay the entire amount for the delivery of those services despite the patient being happy, those services being provided well and, in many cases, those practices having spent considerable amounts of money in delivering the treatment, when you consider the staff, equipment and other resources necessary to provide dental services. This is a problem that has resulted in enormous stress and hardship to a number of dentists and I think it is fair to say that it has threatened the viability of otherwise thriving practices that are providing important dental care to the community. None of us have any sympathy for any practitioner who acts unethically, who seeks to defraud the department, but it is very clear in my view that the vast majority of dentists do not fall into this category. I acknowledge Senator Moore's statements about being familiar with the scheme, and it is important that dentists are, but it is important to put on the record that the government has in fact used terms like 'fraud' and 'rorts' and so on for any dentist who has fallen foul of this scheme, and I think that language is not helpful.

We have worked very hard on this issue. We have met with a number of dentists. We have made repeated representations to government on behalf of affected dentists. I have to say I am very pleased that we have finally seen an announcement by the government on this front. During Senate estimates on 29 May, the Minister for Human Services, Senator Kim Carr, made a very clear statement that included some of the following comments: What matters is the resolve of this department to face up to the mistakes, to fix them and to make sure they do not occur again. I think it is important to recognise that they have acknowledged there have been some mistakes and that they intend to fix them. He went on to say:

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 in line with other parts of Medicare. He went on to talk about the flaws in the scheme and said that the 'determination established different requirements, with less flexibility in implementation, than equivalent schemes elsewhere in Medicare'.

Under Medicare you see a GP, a service is provided and you are essentially bulk-billed or those services are charged through Medicare. In this case, unlike other cases, a referral from a GP to a dentist is necessary and in return that dentist needs to provide a treatment summary to the GP and also needs to provide a written quotation to the patient. In some cases the dentists were not charging any out-of-pocket costs. In some cases the dentists were salaried dentists and stood to gain nothing by manipulating the scheme, and I can understand why some dentists did not see the need to provide a written quote. It makes sense that in those circumstances people would have assumed that that was not necessary. I go back to the point that those requirements were not made clear to all dentists from the outset of the scheme, particularly considering this is a profession that has had very little experience with Medicare. The truth is that the government is seeking to change the regulation that is going to enable them to revisit all of the audits, and I think that is very important. We are pleased that is going to happen and we support the government in its endeavours in this review.

I think now that it is important to discuss the coalition bill, and I do acknowledge that Senator Bushby has worked hard on this issue. It is a somewhat unusual alliance having the Greens and the coalition working together on an issue like this, but on this issue I think it is a reflection of the fact that there has been something seriously wrong with the way the scheme has been administered in this regard and that there has been an injustice committed. We do support the intent of the bill, which is that this injustice be remedied. We do, however, acknowledge that there are concerns around the way the bill is structured and in fact whether this bill would achieve its aims. We have had some advice that there are some serious problems around the way that this bill is structured. The bottom line is that, in light of the minister's announcement, where there is an intent to review all of the audits, as a show of good faith we are going to work with the government on their proposed solution rather than support this bill in the parliament. I will, however, say that this bill could be revisited in the near future if in fact we do not get a resolution to this issue.

We will hold Minister Carr to his word. He said that in his view it was his expectation that some, but by no means all, audit findings will change as a result of the proposed review. In our view, 'some' means the vast majority. It is very clear that, in practical terms—and I go back to the minister's statements—the amended determination will trigger a reassessment of all audit activity. So far, we know that 95 audits have been concluded and 66 practitioners have been found to be non-compliant. What we know about those 66 practitioners is that the vast majority have delivered services to patients who needed them and they in fact have been found to be non-compliant on the basis of a simple administrative error—that is, they have not sent a treatment summary back to the GP or they have not provided a written quote. As I said, in the vast majority of cases that is an insignificant administrative error. As somebody who practises as a GP, I have to say that not getting a treatment summary back from a dentist probably would not make much difference to me. I will speak for myself and some of my colleagues: we would not know the difference between a molar or an incisor. As GPs we do not make good dentists. What we want to know is that a dentist has seen the patient and that the work has been done and the patient is satisfied with that work. That is what is important here. So, in terms of the clinical impact of these administrative decisions, in our view it is insignificant—there is no clinical impact from most of these audits. We have heard about some individual cases. We heard from Senator Bushby about Wilma Johnson. We also have met with Wilma and we wholeheartedly endorse Senator Bushby's comments. There are a number of other dentists involved in these audits, including Helen Arabatzis, Roger Sharpe and Dragon Antolos. Helen Arabatzis, for example, a dentist doing terrific work in my electorate of Victoria, received notification that she would be audited. She was asked to repay hundreds of thousands of dollars, which threatened the viability of a dental practice delivering important services to people in my electorate. That came at a difficult time for Helen; I do not think she will mind my saying that she was heavily pregnant and was facing a number of issues. I think it would be generous to say that the way in which the government has handled this issue has been clumsy and heavy-handed.

We acknowledge the statements made by the Minister for Human Services, Senator Kim Carr. I think it is refreshing in politics to see a minister admit that a mistake has been made and that it is his responsibility to rectify that mistake. We are prepared to work in good faith with the government to resolve these issues. As I have said, it is our expectation that, for the vast majority of the audits that will be reviewed, a different determination will be made, but we reserve our right to revisit this bill in the future should that not occur.

The Chronic Dental Disease Scheme is far from perfect—I acknowledge that. We are working in good faith with the government to replace the scheme with something better. It is a fundamental reform, it is an important reform and it is a reform that is necessary in a country that is as wealthy as Australia and can afford government investment in good oral health. We remain absolutely committed to reforming dental care, but we do believe that no potential reform will succeed unless the dental profession is consulted, is fully engaged and is strongly supportive of any new scheme. That is why it is critical that we resolve this issue and resolve it quickly. It is important for the individual dentists involved, some of whom I have mentioned—it is critical for their individual circumstances—but it is also really important if we are going to go on to develop a national dental scheme that will be an important and significant advance for the health of Australia's community. Overhaul of the scheme is still on our agenda. We are keen to work with the government to find a way to get a government funded scheme that satisfies both the profession and the community.

The response from the government on this issue has created many months—years for some dentists—of terrible stress and uncertainty. We feel for them. We hope that they understand that our decision not to support this bill is a show of good faith and a sign of confidence that the government has acknowledged that an error has been made and that it intends to fix it. The key tasks now are to continue working on the development of a new national dental scheme, to resolve this issue and to allow dentists to get back to doing what they do best: providing critical dental care for the Australian community.

Helen Kroger (Victoria, Liberal Party) Share this | Link to this | Hansard source

I rise to support this bill, the Health Insurance (Dental Services) Bill 2012 [No. 2], which has been proposed by my colleague Senator Bushby, because it is an area of significant concern to those of us on this side of the chamber and it is a subject of great concern that has been raised with me many times in my patron seats of Chisholm, Bruce and Deakin in Victoria.

Dental health in Australia has been—without being too cute—decaying since the day that Labor took office in 2007. This government inherited a successful dental scheme, the Medicare Chronic Disease Dental Scheme, that was introduced by the coalition in government and that provides $4,250 in Medicare dental benefits over two years for eligible patients with chronic dental health disease. About one million patients have benefited from the scheme since 2007, with more than 17 million services having been provided. But the patients who rely on the scheme appear to mean little to this government, which has been, I hate to say, playing politics with the dental health of Australians since it formed government in 2007. Why does the government hate this scheme? I dare say it is because it was introduced by the opposition leader Tony Abbott when he was health minister. What has the Labor Party done subsequently? It has repeatedly tried to scrap it and then, after the Senate rejected Labor's attempts to do that, it has set out to undermine the scheme.

As my coalition colleagues have already mentioned in this chamber, the government established an audit task force in June 2010, resulting in an audit process that has destroyed trust in government funded dental schemes, which is an absolute tragedy. The coalition will always support an audit process that seeks to detect fraud, the misuse of taxpayers' funds and the provision of inappropriate services. After all, it is the job of us in the Senate to ensure that we scrutinise sufficiently everything that goes through this place to make sure that taxpayer funds, which are so hard earned, are spent in the most effective, cautious way so as to ensure value for money. But the government's audit process has been misguided. It has seen hard-working dentists pursued relentlessly over minor, technical mistakes in their paperwork. The advent of this has been raised with me by many dentists, including my own dentist when I went for a check-up not so long ago. In the majority of cases, dentists found to be noncompliant have in fact given appropriate services to their patients. These dentists did not comply with technical requirements, but for many of them it was their first interaction with Medicare. There was no intent to mislead and there certainly was no intent to act in a fraudulent way. Many of these dentists have also even attempted to immediately rectify the situation when they were notified of the error that they had inadvertently committed. Yet the government, who have seemed, particularly in the last couple of years, to have had an extraordinary track record of continuous blunders and incompetence have been absolutely unforgiving and merciless in their approach. They have been totally unforgiving and heartless in their prosecution of these cases.

For years Labor ministers have persevered with claims that dentists who did not comply with minor technical requirements must repay all benefits in full. Let me quote just one of those ministers, the Minister for Health and Ageing, Tanya Plibersek in the other place. I find this particularly concerning. On 20 March 2011, prior to her appointment as minister for health, she was quoted in the Victorian Herald Sun newspaper describing the Medicare dental scheme:

There's a massive blowout. There's just an incentive for dentists to go out and look for people to drag in your practice.

So she was in effect reflecting on the so-called lack of professionalism of our dentists. There is no suggestion that you do not have an occasional one, but to absolutely spray the whole dental profession in this way I thought was a slap in the face for the extraordinary expertise and service that they provide to all Australians. It really demonstrated her disregard for the critical service that they provide and continue to provide to Australians. That she would publicly accuse dentists, some of the most respected and valued professionals in our community, of prioritising money over the health of their patients is despicable.

The minister for health is supposed to be acting in the best interests of the profession and the Australians who they assist. Rather than attempting to damage the standing of dentists, she should be out there doing everything she can to strengthen the position of the profession of dentistry. Yet that is exactly what the minister and her predecessor in this Labor government have done. Reputations have been ruined. Some dentists are even facing bankruptcy. But the government do not seem to be too concerned about that either. They have shown a complete lack of compassion for dentists and the health of the patients that they treat.

Has the government ever stopped to think about how a government-funded dental scheme works? It works with the participation and cooperation of the dental profession—the very same group that has lost trust in the government and the way in which it has presided over this issue. Despite the government promising time and time again that dental health is a priority, there is no evidence to suggest that this is the case. Whilst we are becoming accustomed to the government breaking its promises time after time, this is one area where it has just got to stop.

Constituents in my patron seat in my home state of Victoria, as I have previously said, are crying out for the federal government to give dental health the attention that it so deserves. Melbourne people are waiting up to three years to see a dentist. In February of this year the community newspaper group Leader Community Newspapers reported that the situation had gotten so bad that desperate patients were ringing around to find public dental clinics with shorter waiting times. In some suburbs the waiting times had blown out to 30 months. I know that in the suburb of Box Hill, which is close to my electorate office in Burwood East, it can take up to 20 months for a check-up and 31 months for dentures. I have had someone walk into my office who had lost their dentures and had waited for two years. They were absolutely desperate because they were not able to consume solid food.

With dental health largely excluded from Medicare, that means struggling families sometimes have to book more than two years in advance just for fillings, for check-ups or to have their teeth cleaned. The Liberal state government in Victoria, which inherited these blown-out waiting lists from their Labor predecessors, have acknowledged that these waiting lists are too long. They recognise the importance of dental hygiene to an individual's overall health and are increasing funding to target areas of high need and to address some of the real issues that many people are facing in Victoria.

It is up to this federal government to finally keep its promise and show that dental health is indeed a priority, as it keeps saying. It is time for the government to take some of the pressure off the states and territories with a Medicare dental scheme that actually supports dentists and their patients. Labor has promised to fix health and end the blame game between the federal and state and territory governments, but what we have seen is something quite different. This government needs to realise that talking about dental health is not good enough and that Victorians—in fact, all Australians—are calling for action. Government action might have helped six-year-old Jackson from Melton, who had to endure a two-hour operation at the Melbourne dental hospital in December last year. Jackson had to have no fewer than six teeth removed, five fillings, two root canals and two silver crowns fitted. What a traumatic experience for someone so young!

Even sadder is the fact that he is not the only child struggling with dental health because of lack of access to services. A study by the Australian Institute of Health and Welfare found that more than half of all six-year-olds are affected by teeth decay.

Senator Bilyk interjecting—

That is a hugely troubling statistic, Senator Bilyk. You should listen. You might actually learn something if you listen. It would help you enormously. Why is this government not prioritising funding for dental health and dental education instead of wasting time and taxpayers' money pursuing dentists over minor infractions of the Medicare scheme? It is a disgrace.

The government, in one of its rare initiatives in dental health, introduced the Medicare Teen Dental Plan in 2008, which provides a voucher to eligible teenagers. But the voucher is just for a preventative check and the Australian Dental Association has argued that the scheme is inadequate. It does not provide for follow-up care and is restricted to 12- to 17-year-olds. The report Child Dental Health Survey Australia 2007: 30-year trends in child oral health was released just last month, on 29 May. One of the survey's findings was that:

Thirty-nine per cent of children aged 12 and 60% of children aged 15 had some history of decay in their permanent teeth—that is, one or more decayed, missing and filled permanent teeth.

In the face of this report, I simply cannot understand why the government is failing to act on this. As a mother, I am angry on behalf of all the parents out there who are having to deal with this.

In addition to undermining the successful existing Medicare program, the government has failed to deliver on its own dental health promises. I just mentioned the inadequate Medicare Teen Dental Health Plan, but there was also the Commonwealth Dental Health Program proposed by Labor in 2008. As usual, Labor promised a lot—this Labor government promised an enormous amount—but have delivered very little. Under the Commonwealth Health Dental Program, there was to be funding directed to the states and territories to provide some one million services. Of course, the government did not stop to assess the capacity of the public dental workforce to provide the services. They could have consulted with the Australian Dental Association—I know that the Victorian branch's figures show that only 10 per cent of dentists work in the public sector. So, as usual, the figures Labor used were wrong. Their program could not deliver the one million services promised. I notice that Senator Bilyk has suddenly gone very quiet on the other side of the chamber in the face of some statistics that demonstrate just how they have, once again, dropped the ball. But the figure falls well short of the 17 million services provided by the Medicare dental scheme introduced by a coalition government. The program was scrapped—did you hear that, Senator Bilyk?—in this year's budget. This is yet another broken promise from Labor.

The budget, in fact, provided very little for dental health, despite all the rhetoric coming from the other side of the chamber. There was only approximately $60 million in new funding announced in this budget for dental health care. When you consider the needs of Australians, including those in Victoria, that sum is a drop in the ocean. It will not result in the substantial improvements to dental health care that are needed. The coalition is the only side of politics that has delivered a dental scheme that has made a real difference.

I am very pleased to speak in support of this bill today. It is an area that needs to be rectified. It is an area in which the Labor government have continued to demonstrate their incompetence. For the sake of my constituents in Victoria, I hope that this government supports this bill, finally sees some sense and sees the need for the promotion and support of greater dental health care for all Australians.

Anne Urquhart (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance (Dental Services) Bill 2012 [No. 2]. This is a bill that is just another private member's bill from the opposition that is nothing more than opportunistic grandstanding. This is all while the Gillard Labor government is seeking to provide targeted, means tested support to Australians who need oral health treatment. The Gillard Labor Government is making a targeted $515 million investment in oral health for Australians who are least able to afford dental care. The new spending will see a blitz on public dental waiting lists, oral health promotion, a boost to the dental workforce and improved dental facilities in rural and remote areas.

Let us compare that to the scheme we are debating today that was launched in the last days of the Howard government. The chronic disease dental scheme is not means tested, which means those who can afford to pay can get $4,250 worth of free dental care. It is not targeted, which means patients can get caps, crowns and other often cosmetic work at the taxpayers' expense. All the while, people in rural and remote communities have trouble seeing a dentist at all. The Gillard Labor government's package will cover off on the important foundational work needed to make significant improvements to the dental system. Our package represents a major down payment on a new national dental system, a system Labor people have been lobbying for for many years. This package will include funding of $350 million for a public dental waiting list blitz. According to the national dental advisory council, this will assist the current 400,000 people on waiting lists around the country. The funds will be delivered through a national partnership agreement with the states and territories. In addition, states and territories will be required to maintain their existing effort. This work includes treatment of children and targets for dental services provided to Indigenous Australians. Ten million dollars will be utilised for oral health promotion. This will see the development of a national oral health promotion plan to promote dental services for better oral health. While it is vital that we provide adequate oral health treatment, the best solution is to prevent problems in the first place. With oral health, it can be as simple as everyone brushing their teeth at night and in the morning or as simple as someone going straight to the dentist or GP to be examined as soon as they feel something ajar in their mouth. Treating things early and preventing them in the first place are the best ways to keep healthy. But in order to create a social norm—and we cannot monitor teeth brushing like we can the wearing of seat belts—we need to educate Australians about the best practice.

The package also includes funding of $35 million for the expansion of the Voluntary Dental Graduate Year Program. This will offer 100 additional places per annum to increase the dental workforce. More dentists, more dental nurses and more hygienists will see more dental services delivered through our national system. We are providing $45 million to fund a graduate year program for oral health therapists. This will support 50 placements per annum to increase service delivery capacity and create a more flexible dental workforce. Importantly, Labor is providing up to 100 infrastructure grants and up to 100 relocation grants through funding of $77 million, which will support up to 300 dentists to set up practices in rural areas to meet the current shortage of dental services in rural and remote areas, and $450,000 will be provided to non-government organisations to coordinate further pro bono work by dentists for the most disadvantaged Australians across the country.

While the Gillard Labor government is committed to providing this package to Australians in need of oral health care, those opposite want to continue with their scheme, a scheme which is not targeted or means tested and which has not serviced Australians in need. They demonstrate this support for their failed scheme through this bill—a bill which will do nothing to help Australians get better access to quality care; a bill which merely continues the attitude of those opposite of all show and no delivery; a bill which is not about providing better dental services to the thousands of people who need them; a bill which is just a stunt and proves what a poorly designed scheme this was in the first place. It is a bill which seeks to establish a dangerous precedent—that ignorance is an excuse for not complying with the law. It says to the Australian community that it is okay for dentists not to follow the legislated processes when claiming moneys from the Commonwealth. It says to the Australian community that for one group of professionals—a group with tertiary education—the excuse 'I didn't know' is okay. It is like saying that if a person on the Newstart allowance found work, and did not report that to Centrelink because they had not checked the requirements of claiming Newstart, they should not have to pay back any overpayments. It is like saying that if non-government organisations managing training for the government—for example, for a responsible service of alcohol certificate—do not make their students sit the required test but then put in a claim for funding they should still be paid for the service they performed, even though it is prescribed that students sit a test. Rules are set which are communicated to people and organisations making claims, and it is up to the individual or the organisation to ensure that they comply.

The bill seeks to direct the Minister for Health to carry out functions outside her area of responsibility. Under clause 6 of the bill, the health minister must do one or more specific things in order to 'redress the inequity' that the bill is intended to address. Under clause 6(1)(b), the health minister could provide for the Commonwealth to waive its right to payment of debts arising under section 129AC of the Health Insurance Act 1973 in relation to the dental services. However, under section 34 of the Financial Management and Accountability Act 1997, only the finance minister, not any other minister—neither the health minister nor any other minister—can waive debts. It is not clear how this clause would work in practice, and no amendments have been moved. One can therefore deduce that those opposite are obviously not interested in seeing this bill implemented, they are not interested in seeking a solution for dentists and they are just playing schoolyard politics, time after time after time. One of the specific things the Minister for Health can do under clause 6 of the bill is 'provide for act of grace payments to be made in relation to the dental services'. However, by definition, an act of grace payment is a payment that would not otherwise be authorised by law or is required by statutory command or is required to meet a legal liability from section 33 of the Financial Management and Accountability Act. That is, if a payment is specifically authorised or required by law, it will not be an act of grace payment.

Once again, those opposite have made mistakes in the drafting of the bill, and with no amendments to rectify the mistakes they obviously do not want this bill to be implemented. As this bill raised a number of finance and public administration concerns, it has been considered by the Senate Finance and Public Administration Legislation Committee. The committee recommended that the bill not be supported. The policy of the Gillard Labor government is not to amend this scheme; we want to close it. Since its inception in 2007 under the Howard government, it has been bad policy. It has been insufficiently targeted, which has led to overservicing for some Australians and no servicing for others. As it is not targeted, patients can get caps, crowns and other, often cosmetic, work at the taxpayers' expense, while people in remote communities have trouble seeing a dentist at all. The scheme is not means tested, which means that those who can afford to pay have the opportunity to get the $4,250 worth of free dental care. Added to that, there have been more than a thousand complaints lodged about the scheme, a scheme which comprises only a minor part of Medicare's core function and was so poorly designed that it has seen more complaints than any other area of Medicare. There were more complaints about the dental scheme than in the whole ambit of general practitioners, and they were not just any old complaints. The complaints about the scheme are more harrowing than normal, including some relating to the mistreatment of elderly Australians. For example, Minister Kim Carr told the recent estimates hearings of one dental health practitioner who is alleged to have provided unnecessary treatment, including preparations for crowns, for an elderly patient without the permission of that patient or their representative. This is significant dental treatment, encouraged under the scheme, which was allegedly provided without permission to an elderly patient. And those opposite are proposing that the scheme continue!

They have the nerve to come in here and lecture this chamber day after day after day about compliance with government schemes. The government has a responsibility to ensure that taxpayer dollars are spent appropriately. We have done this with means testing the private health insurance rebate and we are doing it here with our new dental care system. Anyone claiming funds from the Australian taxpayer has an obligation to do so according to the law, and dentists are no exception. The government has provided all known dentists with information about the requirements of the scheme on nine separate occasions. The requirements of the scheme are not onerous. It is not onerous for dentists to tell a patient and their patient's doctor what work they are doing and it is not onerous to tell their patient up-front what the cost will be. Officers in Medicare Australia and now the Department of Human Services have been attempting to come to grips with a scheme that is fundamentally flawed. I commend these officers for their hard work.

As at the end of January 2012, around $2.3 billion dollars had been claimed under the scheme since it commenced under the Howard government in 2007. Of that, $21½ million dollars was found to be in non-compliant claims—that is, the Department of Human Services has identified fewer than one per cent of claims to be noncompliant. Officers from Medicare have been blamed by many for 'not providing sufficient advice'. This is despite the government providing all known dentists with information about the requirements of the Chronic Disease Dental Scheme on nine separate occasions.

On 29 May this year, Minister Kim Carr announced that the government's next steps were to work through the noncompliance of some dentists. The government's view is that we need a retrospective change to the dental services determination within the near future. This change will need to create 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. All these changes will allow Medicare to take a more educative approach when dealing with dentists.

The new changes will not excuse everyone who has fallen foul of the current arrangements. Some practitioners have charged the government for services that were never provided. Some practitioners have flagrantly and repeatedly breached their administrative and patient care obligations. This is unacceptable. The Minister for Health and the Minister for Human Services will ensure that obvious cases of fraud or causing harm will be pursued. The ministers will convene a professional services review process to separate the obvious cases of fraud from the accidental administrative errors. There will be a continuing focus on protecting the interests of patients relating to informed financial consent and on an appropriate exchange of information between the practitioners servicing patients with chronic disease.

Finally, new arrangements are comparable with the equivalent compliance arrangements in other parts of Medicare. In practical terms, the amended determination will trigger a reassessment of all audit activity by the department. To date, almost 100 audits have been concluded, with a high number of practitioners being found to be non-compliant. The noncompliance was due to administrative breaches. Examples of these breaches include not completing appropriate paperwork or not providing patients with quotations before conducting dental health treatment. Remarkably, 12 dentists have been found to be noncompliant due to a failure to actually provide a service. Each of these cases will be worked through again on the basis of a new determination, and in some a new conclusion may be reached.

In addition, there are another 534 audits currently underway, and further consideration will be given to each of these. These will be worked through by the department as speedily as possible. General practitioners are, of course, responsible for following the compliance arrangements in place at any given time, including during times of change. Any failure to follow those arrangements will expose patients to harm and expose practitioners to possible recovery action. The department will continue to investigate complaints from members of the public as they arise and will assess claims of inappropriate dental practice and nonprovision of service.

The government's intention is to close down the scheme as soon as possible. The government will make retrospective changes to the determination to establish more appropriate compliance arrangements. Instead of trying to write off all the debts of non-compliant dentists and amend a flawed scheme, the Gillard Labor government is working with dentists to identify those whose noncompliance was an accidental administrative error.

The Gillard government is making meaningful investments in dental health services, while those opposite are proposing stunt bills that do not work and will create dangerous precedents. I urge all senators to vote against this bill and to support the government's move to address the issue through a retrospective change to the determination.

Scott Ryan (Victoria, Liberal Party, Shadow Parliamentary Secretary for Small Business and Fair Competition) Share this | Link to this | Hansard source

In a number of the contributions I have heard from members of the government now I detect a theme in what they say is the government's agenda—that it is the government's agenda to deal with dental health in this country. The theme very much tends to be, as it historically is with the Labor Party, about funding systems—large numbers, large bureaucracies giving money to waiting lists, or blitzes on waiting lists that, hopefully, might be more successful than what they have done with our public hospitals in recent years.

I will go into what has particularly surprised me about the government's contribution. The difference with this particular program is that it is patient driven. It is not about a government throwing a few hundred million dollars at a state bureaucracy to go on a waiting-list blitz. It is not about a program to get trainees or hygienists in; it is actually very much focused on patient need and patient demand. If we have a criticism of the program it is that it is not as accessible for people in remote Australia as it is for people in the city, and the same criticism can be made of Medicare. With Medicare more generally, and access to GPs, let alone specialist services—we know the data on cancer survival rates tells us the same thing—we do not say we are not going to have a Medicare program because people in remote Australia do not have as much access to it. We try to ameliorate that.

The flaw in the government's argument is that it contradicts the very point that Labor once made about the universality of Medicare. The point they make, and they have made it with respect to psychologists as well, is that because this program is not means-tested certain people are benefiting more than others, people who might not need as much public subsidy. That completely contradicts the very philosophy of Medicare—and I see government senators nodding. The very philosophy of Medicare was about universality; it was about not means-testing it. Yet what we have here are members of the Labor Party, the people who claim that Medicare and Medibank were their inventions, saying, effectively, that we should be means-testing access to this program. You cannot offer a criticism of a Medicare program by saying it benefits some people more than others—those who might not have the same need from an income perspective—without undermining the universality of Medicare itself. That is the complete contradiction in what the Labor Party are proposing.

No-one is denying the possibility of events of fraud in any government program. We might have one or two examples of fraud in this program—and if they are proven those cases should be prosecuted to the nth degree of the law—but no-one is alleging that the services were not needed by patients or that they were not delivered to patients. What we are talking about here are administrative issues. Just because the previous speaker, Senator Urquhart, said that there were examples of fraud in the system does not mean the program should be closed down. The same logic would suggest that bulk-billing fraud in the GP system means we should shut down bulk-billing for GPs—and access for the three-quarters of Australians who use GPs who bulk-bill. That argument simply does not make sense. What we need to do is ensure that there is as little fraud as possible and prosecute those who are responsible.

But this is not about fraud. What this is about is this government's agenda to try to shut down a program that was instituted by the previous government, a program that has been successful. This program has delivered dental services to those in need—they have just been delivered to a group of people different from those the Labor Party would prefer had access to those services. The Labor Party's programs to address dental health have not succeeded. This program has been a success. The fact that there have been one or two instances of fraud does not in any way suggest that we should remove the program. Hundreds of thousands of Australians have accessed dental services that are important to their health.

It is conceded that administrative oversights have occurred, but no-one is arguing that that represents a substantial flaw in the delivery of dental services. I know a number of dentists who have provided these services and it is clear to me that one of the reasons there has been more administrative hassle in the provision of dental services than in the broader Medicare program is that dentists are not particularly familiar with the Medicare system. Dentists are not part of Medicare—unlike GPs, specialists and other service providers. So it is entirely understandable that dentists do not have the systems or the experience to allow them to process the forms on time, submit them by their due date and comply with the bureaucratic paperwork and procedures of Medicare Australia. That is not to say that we should not aspire to those administrative criteria being met, but what we are saying here is that there is no need to unwind the entire system, a successful system, purely because of some paperwork errors. Again, we go back to the point that no one is alleging these services, in the overwhelming majority of cases, were not delivered to patients in need. The fact that some people in need do not get access to a service does not provide an intellectual case for stripping it from others who are also in need. We do not use that logic with the broader Medicare system. Instead, we try to tailor additional programs.

One of the previous speakers talked about training numbers and how we need more dentists. That is true. There is a substantial need for greater numbers of dentists—an increase in numbers would generate a supply-side impact that would both reduce costs and increase availability. One of the challenges in dental care is that the level of unutilised dental services is not high. In my home state, the major facility for training dentists is the dental hospital associated with the University of Melbourne. When the old dental hospital moved to the new dental hospital site, most Victorians noted that it was no bigger. It may, in fact, even have been smaller. There was no expansion in the number of dental places. My home city of Melbourne has grown by almost a million people in the last 15 years. In this morning's paper I read that, according to the most recent census data, Victoria's population has grown by just under half a million people over the last five years, yet there has been no expansion in the number of dental training places.

I point out that this new dental hospital was built and opened under a Labor state government. As with everything else in our health system, there was no focus on increasing the supply of services to meet the substantial increase in population which has been taking place in Victoria over the last decade. That is one of the flaws in our dental system and it is something the current state government is actually doing something about.

This bill is important because it will put the Medicare Chronic Disease Dental Scheme back on a solid footing. It will do this by giving the minister the responsibility and the flexibility to make sure the focus is again on dentists delivering services—rather than trying to penalise them for services that have been delivered but for which bureaucratic requirements have not been met.

In a bill about the powers of the Auditor-General debated in this place earlier this year—guillotined, in fact—I raised a number of concerns about the new powers being given to the Auditor-General to investigate anyone who was in receipt of Commonwealth money. I raise that in relation to this bill because dental surgeries are genuine small businesses—sole operators or partnerships employing a handful of people. Some dental surgeries are larger, with maybe half a dozen staff, but basically they are all still small businesses in the classic Australian sense. At one dental surgery in Melbourne I went to, I saw requests for information from Medicare Australia that did not show any understanding of the paperwork requirements those requests were going to place on this particular practice. For a number of weeks this practice had to devote their most experienced dental nurse to doing nothing other than Medicare Australia paperwork. I take the point that this is all because there were some requirements for administrative oversights. However, I made the point earlier that dentists do not have the greatest amount of experience with Medicare, and so part of the flaw may well be the requirements we have placed upon them—unlike people in general practice or specialists, they do not have a great deal of experience in operating with Medicare Australia and those requirements. The whole point is that taking a senior dental nurse away from patients to spend a month pulling together paperwork for Medicare Australia to do one of these audits struck me as a perverse use of limited dental resources.

I make the point about the powers of the Auditor-General in passing because under the bill I referred to earlier the Auditor-General now has the power to audit any small business in Australia that is in receipt of commonwealth funding. It is not just state governments—it could go down to a person who, maybe under education program funding, paints a school building. They could be audited by the Auditor-General. I did not get the opportunity to speak in that Auditor-General debate at length because it was another one of those bills that the Greens and Labor guillotined, and the bill and amendments were put to a vote without any debate in this chamber. What is happening to dentists all around Australia who are being subject to Medicare Australia audits, without the facilities, or experience or otherwise the wherewithal to deal with requests for information, is something that small business in Australia should be concerned about. While the current Auditor-General, Mr McPhee, has made clear he does not intend to use the powers in that way, my concern has always been that when you grant someone power you cannot always guarantee that at some point in the future someone else will not inadvertently or otherwise create the same problem that you are afraid of and that you were promised would not occur.

This bill gives the minister the power effectively to waive or amend the administrative requirements in such a way to ensure that dentists can continue to deliver the services their patients need. What concerns me about the approach of Labor, and the speakers I have heard before me in this debate, is that we hear about constant funding for systems. This approach relies on GPs referring people to dentists for needed medical care. No-one has yet mounted a case for how that system fails to serve the needs of patients. The only criticism of it so far is that the government would prefer money to be spent treating different people. In a previous life, the Labor Party, under the Keating government, had a three-year program for reducing dental waiting lists. That program was not renewed in 1996.

Catryna Bilyk (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

You scrapped it.

Scott Ryan (Victoria, Liberal Party, Shadow Parliamentary Secretary for Small Business and Fair Competition) Share this | Link to this | Hansard source

There was no scrapping—it was a three-year program. That is what happens when programs come to the end of their life. At its core it was a failure of state governments to live up to their responsibilities, because dental care has not historically been a Commonwealth responsibility. I once thought Labor were proud defenders and proponents of the Medicare system but now they seem to be arguing that we should be means-testing Medicare or that we cannot have a particular program as it goes to the wrong kind of people, completely contrary to the notion of universality; completely contrary to the notion of universal health insurance. No-one is denied access to dental care under this program if they meet the criteria. The test is not income. While there are challenges around people in remote and rural Australia accessing health and medical care, that is just as serious when it comes to other aspects of health and medical care. So that argument does not add up.

The coalition stands by the Chronic Disease Dental Scheme. Hundreds of thousands of Australians have benefited from it. We hope hundreds of thousands of Australians will continue to benefit from it. We know the dentists have overwhelmingly acted in good faith. We know that because of their lack of experience with the Medicare system there have been some administrative oversights. But nothing the government or the Greens have said challenges the notion that these are services that have been appropriately delivered to patients in need. The small number of examples of potential fraud should be investigated and prosecuted to the maximum extent possible—but these things also happen in the broader Medicare system, so it is not logical to say that because they happen the system should be wound back. I commend the bill.

Catryna Bilyk (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on the Health Insurance (Dental Services) Bill 2012. This private senator's bill is a flawed bill about a flawed scheme. Senator Bushby should be embarrassed to have this bill tabled in the Senate. I think Senator Kroger said she thought the dental schemes and health schemes were decaying, but in response to that there are plenty of holes in this bill.

Before I go on to what is wrong with this bill, which is no more than a political stunt by the opposition, I will take some time to talk about the Chronic Disease Dental Scheme and what a shambles it was. The CDDS was introduced in the dying months of the Howard government, as we know, after they scrapped the Keating government's state funding for services targeting those on low incomes, introduced in 1994. We have heard Senator Ryan's arguments on why the coalition scrapped that, but they could have continued to fund it and they chose not to. The CDDS provides up to $4,250 in Medicare benefits for dental services over two consecutive calendar years to eligible patients who have a chronic medical condition or complex care needs. The patient must be referred by their general practitioner for dental services, and their oral health must be impacting on or likely to impact on their general health.

While this all sounds reasonable and good, it is a scheme that has been poorly targeted in terms of addressing the genuine dental needs of Australians, and it has been open to misuse. To give senators a few examples of why this scheme was flawed, I offer the following. The CDDS, as we have heard from speakers on this side before, is not means tested. This means that millionaires can get up to $4,250 worth of free dental treatment at taxpayers' expense; and, because the scheme is not targeted, this treatment could include cosmetic dental work such as caps and crowns. Some of the misuses of the scheme include unnecessary crowns, ordering dentures that do not fit—as we have heard from previous speakers—and dentists charging the full $4,250 without completing the work.

More than 1,000 complaints have been lodged about the CDDS, demonstrating that it is a flawed and poorly targeted scheme. That is why the Labor government have been trying since 2008 to shut the scheme down, but we have not been able to get the legislation through the Senate. This is a scheme that had just under $400 million budgeted for it over the forward estimates from the 2007-08 budget, yet at the end of January 2012 total expenditure on the scheme has been a staggering $2.3 billion. That is right: $2.3 billion. So not only is it a flawed scheme that was badly targeted but the cost of the scheme has massively blown out.

If we could free up the money for this flawed scheme, we could provide investment in dental services where it is really needed, because we all know that it is difficult for Australians in rural and remote areas to access dental services. This is why the Gillard Labor government are already making a targeted investment of just over $500 million over four years to improve the oral health of Australians who are least able to afford dental care. This funding includes a public dental waiting list blitz delivered through a national partnership agreement with the states and territories, the development of a national oral health promotion plan, the expansion of the Voluntary Dental Health Graduate Year Program, funding for a graduate year program for oral health therapists, rural and remote infrastructure and relocation grants for dentists, and funding to non-government organisations to coordinate pro bono work by dentists for the most disadvantaged Australians across the country. Of course, we could be doing a lot more for the oral health of Australians who really need it if the opposition would get out of the way and help us close down this flawed scheme.

I will get back to Senator Bushby's bill. We know there have been problems with dentists meeting the requirements of the scheme; we do not deny that. Currently, the Department of Human Services has identified some $21 million for recovery, of which around $260,000 has been repaid so far. Some dentists have claimed that they were not adequately advised of their responsibilities before the scheme commenced. But, once the scheme commenced, there were many pieces of correspondence and advice explaining what was required of dentists. To put this in context, $21 million has been identified for recovery out of a total of $2.3 billion spent on the overall scheme—

Senator Bushby interjecting—

and there was adequate notice given through pieces of correspondence and advice, once the scheme commenced, explaining what the details of the scheme were. The requirements of the scheme are not onerous, and the government have notified dentists of these requirements on nine separate occasions—nine separate occasions. Let me make it clear, though, that, while there are some cases of inappropriate claims and fraudulent claims, I understand that there are cases of dentists generally not complying with the administrative requirements of the scheme, even when their treatment has been delivered in accordance with the scheme. I know this because my office has had several representations from at least one of these dentists, who has a significant debt to the Commonwealth. However, I do not believe that in all these cases dentists should be excused from the requirements of the scheme. Most of the non-compliance cases arise from a failure to meet two simple requirements, and they are to provide the patient with an upfront statement of the costs of the treatment and to provide the patient with a treatment plan outlining what work the dentist is undertaking. The Department of Human Services made it clear that it considers these to be core requirements of the scheme.

Dentists gave evidence to the inquiry into the bill by the Senate Finance and Public Administration Legislation Committee explaining why they considered these requirements to be important. As one dentist submitted:

One rule in particular—namely the provision of an itemised treatment plan and written quotation before treatment begins—is a fundamental safeguard that must be upheld rigorously to ensure the provision of (1) good medicine, (2) patient acceptance, (3) provider compliance, and (4) transparency for audit and complaint resolution purposes. This is no different from the underlying expectation the Dental Board of Australia places on dental practitioners to provide services to privately paying patients in this country.

So what Senator Bushby proposes to do with this bill is establish ignorance as an excuse for noncompliance with the law, but it also directs the Minister for Health to undertake actions that are the responsibility of other ministers.

If we examine each of the decisions the Minister for Health can make under clause 6 of the bill in respect of a CDDS debt, we can see how sloppily assembled this bill is. For example, the bill allows the minister to provide for the Commonwealth to waive its right to payment of debts arising under the Health Insurance Act in relation to dental services. It is unclear how this provision would work in practice, given that under the Financial Management and Accountability Act only the minister for finance can waive debts to the Commonwealth. The bill also allows the Minister for Health to make acts of grace payments. However, under the Financial Management and Accountability Act, an act of grace payment is one which would not otherwise be authorised by law or required by statutory command or required to meet a legal liability. So there is an inherent contradiction in proposed section 6(1)(c) of the bill.

The committee noted that there was fairly extensive evidence given by the Department of Human Services about the extent to which they had gone to educate dentists about their obligations under the scheme, and the department provided the committee with examples of documents where the requirements of the CDDS were made very, very clear.

While dental practitioner groups, such as the Australian Dental Association, indicated to the committee that they were supportive of Senator Bushby's bill, the Australian Medical Association had some very good grounds for opposing it. It is ironic that this bill refers to the liability of non-compliant dentists as an inequity, when the AMA submitted that it is the bill itself that would create inequity. The AMA did not support exonerating one class of medical practitioners—that is, dentists—when it comes to meeting their legal requirements when billing Medicare items. Quoting the AMA's submission:

We do not consider it appropriate that dentists can use 'I did not know' as a defence against future non-compliance with the Determination. Nor do we consider it appropriate for Parliament to provide this defence by passing the Bill, particularly as we are not aware that this defence exists in any other Commonwealth law.

Now, the Minister for Human Services, Senator Kim Carr, is aware of the issues that dentists have with Medicare's approach to compliance with the CDDS and has made the very sensible decision to have a retrospective look at the compliance arrangements. This approach, announced by the minister during budget estimates a few weeks ago, is much more sensible than that proposed by the ridiculous bill currently before the Senate. So Minister Carr will ask the department to look through each of the 66 noncompliance cases on a case-by-case basis and in some cases a new conclusion may be reached. But let us make one thing clear: this is not a free pass for dentists. It should be recognised that there are noncompliance cases where dentists have flagrantly breached their administrative and patient care obligations and some cases where dentists have even charged the government for services that were never provided. I would like to think that those on the other side would not support that sort of behaviour.

I reiterate that it remains the government's intention to close down the CDDS and replace it with a national dental scheme that is targeted to the Australians who need it most. I am confident that, through our negotiations with the Greens and the Independents, we can secure such a scheme. Consequently, I hope we can secure the support we need to shut down this shambolic scheme that is a remnant of a failed Howard government which did nothing in 12 years of government to address the real needs of Australians on public dental waiting lists.

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

Sue Boyce (Queensland, Liberal Party) Share this | Link to this | Hansard source

I also rise to speak on this very worthwhile bill that Senator Bushby has put before the Senate. I think it is to their shame that the government themselves have not undertaken this. But why would we expect it? They are so into the prospect of the politics of envy that they even cannot see their way clear to be fair when they have created a very unfair situation. Clearly the dental community of Australia has been added to the government's list of rich organisations that just deserve to be slammed—rich individuals who should be struck down and criticised and slandered at every opportunity simply for trying to go about their job. The unfairness of the whole situation for dentists I think could be very ably remedied. Unfortunately, despite the government's need to admit how poorly they have performed in this area, with Minister Kim Carr coming out and saying, 'Yes, we will stop persecuting these dentists now that you have finally forced us into that situation,' the persecution of dentists under this scheme has been appalling.

Everyone in Australia would see a universal dental care system as being a long-term goal to be achieved. We all know that oral disease and disorders create short-term and prolonged physical discomfort. Pain, infection and tooth loss are the most common consequences of oral disease. It can cause difficulties with chewing, swallowing and speaking and can disrupt sleep and productivity. The National Survey of Adult Oral Health 2004-06 indicated that, of the Australian population, 17.4 per cent avoided foods due to dental problems, 15.1 per cent experienced toothache and 21.6 per cent experienced orofacial—jaw, for the non-dental amongst us—pain. Dental disease can lead to destruction of soft tissues in the mouth, leading to lasting disability and, in rare cases, death. It is an ongoing problem. International research indicates that there are associations between chronic oral infections and heart and lung disease, stroke, low birth weight and premature birth.

What do we see from this government in response to that very serious chronic problem that the coalition identified and sought to redress with their Chronic Disease Dental Scheme, which Senator Fierravanti-Wells has spoken of? She pointed out the statistics on the huge success of that program, which did look at the ongoing issues in the general health area, and for the economy, caused by chronic disease. What did the government want to do? They wanted to get rid of that system and introduce instead a voucher system for teenagers, which was not even designed to make available any real treatment. It was simply preventative. Yet we already know that there are many young children and many teenagers with very poor oral health and very poor teeth because public access has been restricted by the states and others.

The long-term solution here is genuine access to a dental health system, not this government's attempts to persecute a few dentists who, in most cases, made technical mistakes trying to use a system that has achieved a great outcome for people but of course was much maligned, opposed and abhorred by the Labor government, who saw something successful that was giving a decent return to dentists who undertook treatment and giving real solutions to patients. Far better, from this government's envy politics position, to rip that out and persecute the people who were assisting those with chronic dental problems.

Debate interrupted.