Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Hansard source

Further to my remarks earlier, I would like to add that the Labor Party has no prouder legacy than our contribution to universal health coverage in Australia, most importantly through the two key pillars in Medicare and the PBS. The Albanese government is committed to protecting and strengthening our world-class Medicare system. I'd like to thank the members for Riverina, Macarthur, Braddon, Kooyong and Grey for their important contributions to this debate today.

Australia's universal healthcare system, Medicare, provides free or subsidised access for all Australians to most healthcare services. This bill strengthens Medicare compliance powers and will assist with the investigation and recovery of debts associated with inappropriate Medicare billing. Medicare, including the Medicare Benefits Schedule, or the MBS, and the Pharmaceutical Benefits Scheme, or the PBS, will continue to provide Australians with access to free hospital care and more affordable health care and medicines. The Child Dental Benefits Scheme, or the CDBS, provides access to dental services for children. The Australian government's expenditure on the MBS, the PBS and the CDBS is projected to be nearly $44 billion in 2021-22.

As stewards of this investment in the health of Australians, the government are committed to protecting the integrity and financial viability of Medicare, ensuring that Australians may continue to have access to our world-class health system. While the vast majority of healthcare providers do the right thing when claiming Medicare benefits, there is unfortunately a small number that do not. In most cases, these are a result of mistakes and administrative errors, but, in some cases, these are a result of incorrect or inappropriate claiming and, at worst, fraud. The Department of Health and Aged Care supports practitioners, healthcare organisations and peak bodies to correctly claim health payments with a clear focus on education, engagement and consultation. However, ensuring rigorous, effective health practitioner compliance and identifying healthcare practitioners that are not doing the right thing are vital to protecting the integrity of Medicare.

Historically, compliance activities have concentrated on the behaviour of individual practitioners, on the principle that practitioners are ultimately responsible for what is billed under their Medicare provider numbers. While this principle remains critical, the government needs to adapt its compliance arrangements to an environment where corporations are employing or otherwise engaging practitioners and are increasingly involved in, and influencing the provision of, healthcare services.

The primary intent of this bill is both to strengthen the compliance powers of the Professional Services Review, or the PSR, and to add a degree of flexibility to the PSR's ability to address the inappropriate practice of corporations. The bill is in four parts. Part 1 amends the PSR scheme, part 2 amends certain debt-recovery decisions, part 3 amends miscellaneous debt recovery arrangements and part 4 amends the giving of false or misleading information.

The PSR addresses the behaviour of practitioners that may have engaged in inappropriate practice through review by the director or by committees comprised of professional peers of the person under review. As an alternative to lengthy, resource-intensive reviews by a committee, the director may enter into written agreements with practitioners who are prepared to acknowledge their inappropriate practice and agree to specified actions.

The PSR may also review the practice of corporations that have knowingly, recklessly or negligently caused or permitted their practitioners to engage in inappropriate practice. Currently, such conduct by a body corporate may be reviewed only by a committee. The bill amends section 92 of the Health Insurance Act 1973, which authorises the making of agreements with the director, to ensure all persons under review have the opportunity to negotiate an agreement.

There can be significant consequences for an individual or body corporate referred to a committee, including publication of findings. However, agreements made under section 92 are confidential, and this encourages cooperation.

In essence, the bill extends provisions for written agreements currently applicable only to individual practitioners to include a practitioner who personally renders or initiates services; an individual, who may be a practitioner, who employs or otherwise engages practitioners; an officer, who may be a practitioner, of a body corporate which employs or otherwise engages practitioners; or a body corporate which employs or otherwise engages practitioners.

The new provisions allow the director to come to an agreement with a person under review, including a body corporate or nonpractitioner, who acknowledges inappropriate practice and agrees to specified actions. The specified actions for bodies corporate may include repayment of Medicare or dental benefits paid for services that were rendered or initiated during the review period, a reprimand by the director, counselling by the director, and a requirement for the body corporate under review to provide remediating education to persons that it employs or engages.

To be clear, a corporation's acknowledgement of inappropriate practice has no bearing on the practitioners it employs or otherwise engages. Individual practitioners will not be named in agreements with corporations or other persons who employ or otherwise engage practitioners, and such agreements are themselves confidential.

In entering into an agreement with the director, a body corporate or other person who employs or otherwise engages practitioners would acknowledge that they engaged in inappropriate practice by knowingly, recklessly or negligently causing or permitting one or more of its practitioners to engage in inappropriate practice. That acknowledgement is not binding on any individual practitioner, nor does it result in any findings being made in relation to individual practitioners.

If an individual practitioner were the subject of a separate referral, they would have the option to seek an agreement with a director or to proceed to review by a committee. The acknowledgement by the person who employed or otherwise engaged the practitioner would not be put before the committee, and a finding of inappropriate practice could only be made following an examination of an appropriate example of clinical records and evidence from the practitioner or any other witnesses.

As a consequence of the new provisions relating to corporations, and to maintain its peer review function, the bill adjusts the composition of the determining authority so that it may include additional members of the same profession as the relevant practitioners engaged or employed by the person under review.

The government's commitment to improving compliance is embodied in new sanctions against behaviour that stymies the government's ability to review inappropriate practice and to recover Commonwealth debts created by agreements between persons under review and the director.

The bill creates an exception to the general rule that agreements made under section 92 are confidential by giving the director the discretion to publish details of an agreement where the person under review has not fulfilled their obligations. The person under review will have an opportunity to make submissions about their compliance or otherwise. To further protect the integrity of the scheme against persons, particularly corporations, reneging on agreed terms, the government will have the ability to garnish bank accounts, bringing repayments under section 92 agreements in line with other debt recovery provisions currently permitted under the Health Insurance Act 1973. Garnishee notices will only be issued if persons under review do not promptly engage with the department on repayment or breach an agreement to pay the debt by instalments.

Access to information is essential for the PSR to carry out reviews. The bill introduces offences for persons under review that fail to appear at committee hearings or fail to give evidence or answer questions where required by committees. Maximum penalties for noncompliance will be fines of 150 penalty units, or $33,300 at current rates, for bodies corporate and 30 penalty units, or $6,660 at current rates, for non-practitioner individuals.

The bill also provides for an offence where a person, other than a person under review who is a practitioner, fails to respond to a notice to provide documents to the director or to a committee with fines of up to 30 penalty units. The PSR will also be able to take court action seeking a civil penalty of up to 30 penalty units, currently $6,660 each, for each day that a body corporate contravenes the Health Insurance Act 1973 by failing to respond to a notice to provide documents. Further, the director will be able to apply for court orders for a body corporate to comply with notices.

Following recent observations of the Federal Court regarding jurisdictional fact, the bill also clarifies that a referral to the PSR may be made where it appears that there is the possibility that a person may have engaged in inappropriate practice in the provision of services. Under the PSR scheme, it is ultimately a matter for the PSR to investigate whether a person has provided services and whether the conduct of the person under review in relation to the rendering or initiation of those services amounts to inappropriate practice.

The bill also addresses inconsistencies arising from the introduction of legislation in 2018 to improve debt recovery powers under the Health Insurance Act 1973, the National Health Act 1953 and the Dental Benefits Act 2008. The bill introduces amendments clarifying the application of debt recovery provisions, the use of financial information powers, the recovery of Commonwealth debts from estates, the recovery of interest on Commonwealth debts and the administrative penalties for debts under the Shared Debt Recovery Scheme.

Finally, the bill amends the National Health Act 1953 and the Dental Benefits Act 2008 to mirror recent changes to the Health Insurance Act 1973. The December 2020 amendments to the Health Insurance Act 1973 clarified that the Commonwealth may recover incorrect payments made as a result of the giving of false or misleading information. Maintaining universal access to health care through Medicare is a priority for this government. The bill protects the integrity of Medicare for all Australians, and I commend the bill to the House.

Question agreed to.

Bill read a second time.

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