Monique Ryan (Kooyong, Independent) Share this | Hansard source

I rise today to speak on the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025, a bill which seeks to strengthen the integrity of our Medicare system. It is entirely appropriate that the government take all steps necessary to safeguard the sustainability of our universal healthcare system. Australians deserve confidence that their Medicare contributions are being used responsibly and that our system is well regulated and protected from abuse.

The legislation currently before the House came out of the independent review of Medicare integrity and compliance, the Philip review. The Philip review was commissioned by the Minister for Health and Aged Care in November 2022 in response to fairly widespread allegations of widespread fraud in the Medicare system. Ultimately, that review dismissed the claims of an $8 billion fraud, claims which had been widely and harmfully trumpeted in the mainstream media. In fact, the Philip review found that the allegations were both inflated and speculative. The Philip review found that issues with the Medicare compliance of doctors are overwhelmingly caused by the complexity of the system. It found that Medicare is becoming outdated, that it doesn't reflect the changing needs of our healthcare system. Dr Philip cautioned that, without significant attention to the legislation, the governance, the systems, the processes and the tools of our Medicare system, which he found to be currently unfit for purpose, significant levels of fraud could well ensue.

There are a number of real and increasing vulnerabilities in our Medicare system, which were described and elucidated in the Philip review. These include the changing burden of disease in Australia, the necessary and natural changing nature of healthcare delivery over time, the unnecessarily complex and challenging nature of the Medicare Benefits Schedule, the growing corporatisation of medicine in this country, the increasing uptake and complexity of medical billing software, the opaque nature of MBS billing arrangements in public hospitals and the lack of continuous monitoring and compliance services within our public health system. Dr Philip's review acknowledged that, with more than 3000 items, it's impossible to keep up with the MBS. But those changes continue. In fact as late as last week the Minister for Health and Ageing was proposing further changes to the MBS. It is little wonder that GPs and other health professionals struggle to keep up with compliance.

This bill grants the chief executive of Medicare and their delegates expansive powers which are some concern. Under new section 129AACA any person, not just providers, can be compelled to produce relevant material within 21 days. This includes patients' records, correspondence and billing data. There is no requirement for a warrant, no judicial oversight and no obligation to explain why that information is needed. Failure to comply within 21 days is an strict liability offence with penalties of up to $50,000. This is a profound shift in the settings around such inquiries, and doctors very understandably have real concerns that these changes could override privacy protections under the Privacy Act and legal professional privilege.

There's also a significant degree of nervousness amongst medical professionals regarding the Professional Services Review and other professional compliance bodies. These concerns relate to a lack of transparency in their processes. Those fears might well be exacerbated by this bill's removal of restrictions on the admission of information obtained under the Professional Services Review agency's notices to other investigations, such as those commissioned by Australian Health Practitioner Regulation Agency or the Medical Board. While these are limited to certain circumstances, the fact that they include cases in which the practitioner is not the subject of the original investigation is concerning. There's a reasonable concern that the change might undermine the principle of procedural fairness and risk lessened cooperation with investigations by those bodies. If medical professionals fear that any information they provide may later be used later to prosecute them, it's hardly surprising that they may hesitate to engage with those investigations.

Finally, the bill introduces new powers to recover overpayments from practitioners even if they were not responsible for the error, even if they did not receive the funds, even if they were victims of fraud. The only requirement is that the practitioner was named on the claim form. This could include junior doctors, locums and deceased practitioners whose provider numbers were misused. The growing corporatisation of medicine has greatly weakened the previously simple relationship between provider, patient and payment. It often leads to practitioners being utterly unaware of what is being billed in their name. Doctors in public hospitals in particular often have limited oversight of or control over billing undertaken in their names months or years after the fact. As the Philip review found, much of the leakage in the Medicare system stems from errors, not from malice, and we shouldn't conflate the two. We must ensure recovery powers are exercised with fairness and discretion. Innocent medical practitioners can't be held liable for systemic failures or even criminal acts beyond their control.

I do support the goal of improving the integrity of Medicare, but rather than piecemeal pieces of legislation like this we should be looking at big picture Medicare reform. As has been set out innumerable independent reviews, this should strengthen the governance model overseeing Medicare, it should enable continuous monitoring of claims transactions and it should redesign frontline processes and business rules to support earlier identification of fraud and of serious noncompliance. It should redesign the payment system to a level of capability commensurate with the size and complexity of the scheme, and it should review the legislative basis of Medicare to include a more contemporary basis to regulation.

As the Philip review found, our Medicare system is overly fragmented. It's disjointed and is lacking in contemporary tools to detect and address noncompliance and fraud. That is not the fault of the medical professionals who do their very best within it. I commend this bill to the House, but I do wish that it had more vision and more effect.

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