Thursday, 29 October 2020
Health Insurance Amendment (Compliance Administration) Bill 2020; Second Reading
That this bill be now read a second time.
The bill makes minor but necessary changes to the Health Insurance Act 1973 to make clearer current arrangements for recovery of Medicare payments owed to the Commonwealth.
The bill corrects a possible misunderstanding about the operation of the act. Medicare benefits are recoverable if incorrect information provided in connection with a claim leads to an overpayment, even if the information was not intentionally incorrect.
The bill will also provide government the flexibility to adapt to changes in the way Medicare claims might be made in the future. It is worth recalling that the provisions for recovery of amounts overpaid were first enacted more than three decades ago, that is—in digital technology time frames, at least—eons ago.
Technological advances in Medicare claiming may be easily accommodated because of the stipulation that it is the giving of information, regardless of its form, rather than the making of a statement that will be the basis for a claim for Medicare payments.
Critically, these amendments will help protect the integrity and financial viability of the Medicare program that each year provides for hundreds of millions of services through billions of dollars in benefits. In 2018-19, for example, there were 424 million Medicare services, with benefits totalling $24 billion.
The vast majority of practitioners do the right thing—only a small proportion of Medicare services are claimed incorrectly, but given the quantum of money involved they comprise significant recoverable amounts nevertheless. These amendments will ensure that the Commonwealth may continue to recover overpayments and continue to protect Australia's universal healthcare system.
The Medicare program gives Australians access to world-class and affordable health care by providing benefits or rebates for around 6,000 services, each with its own item number, listed on the Medicare Benefits Schedule. The schedule's services are specified in regulations, which require that practitioners fulfil the criteria described in items before Medicare benefits are payable.
Subsection 129AC(1) of the Health Insurance Act 1973enables the Commonwealth to recover amounts overpaid for incorrectly claimed Medicare benefits or payments where a false or misleading statement has led to a payment that should not have been made.
The amendments to subsection 129AC(1) will clarify for practitioners its intended operation—that is, that the Commonwealth can seek to recover Medicare benefits and payments because of false or misleading information provided in relation to a claim, whether or not the information was intentionally incorrect.
Under the amendments, it is immaterial whether the false or misleading information is given:
This will ensure recoveries are possible where claims have been made through digital claiming channels. Currently, no amounts can be recovered from a person under subsection 129AC(1) unless the Commonwealth has given the person a clear, written explanation of its decision to recover the amount. This bill retains these protections, ensuring that anyone who may be found to have received recoverable amounts has the opportunity to understand the reason for the decision and to submit evidence and has the right to a formal review under legislation.
These changes do not impose additional requirements upon practitioners. Practitioners are currently responsible for ensuring that all claims they make are accurate and correct. This will not alter, and, critically, no patients will be affected by these amendments. The bill retains the provision that overpayments are recovered from the person who was responsible for the false or misleading information, even if the Medicare benefit was paid to the patient or another third party.
The amendments will apply retrospectively, to ensure that any incorrect claims or payments made prior to the passage of this bill may be recovered.
The amendments do not change the lawful basis for which Medicare benefits or payments are payable and, as such, do not affect a person's existing rights. I commend the bill to the House.