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

I present the explanatory memorandum to the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2022, and I move:

That this bill be now read a second time.

The Australian government is committed to protecting the integrity of the Medicare program. Rigorous and effective health-provider compliance is a vital component of this commitment. The behaviour of individual practitioners remains a critical focus, but the government is adapting its compliance arrangements for corporations in recognition that they are increasingly involved in and influencing the provision of healthcare services.

The bill both strengthens and adds flexibility to compliance powers, especially the ability of the Professional Services Review to address the inappropriate practice of corporations. In essence, the bill extends provisions that are currently applicable only to individual practitioners to corporations and other nonpractitioners. The new provisions allow the director to come to an agreement with a body corporate or nonpractitioner as an alternative to a lengthy review by a committee. This is a valuable and practical addition to the PSR's toolkit, facilitating confidential agreements with corporations while still ensuring that the PSR properly addresses inappropriate practice.

It must be emphasised, however, that, while the bill strengthens compliance arrangements in respect of corporations, it also protects practitioners employed or otherwise engaged by corporations that acknowledge inappropriate practice. To be clear, individual practitioners will not be named in agreements with corporations. To encourage compliance, the director of the PSR will have discretion whether or not to publish details of the agreement when its terms are not fulfilled.

The government's commitment to improved compliance is demonstrated through new sanctions, including civil penalties, to discourage behaviour that interferes with the ability of the PSR to review inappropriate practice and the Commonwealth's ability to recover debts formed in agreement between persons under review and the director. In addition, the director will be able to apply for court orders that require non-responsive corporations to comply with notices to produce information.

Another important safeguard protecting the compliance terms negotiated in agreements is the extension of the government's ability to garnishee the bank accounts of persons and corporations that renege on agreements to repay a debt to the Commonwealth.

The bill also clarifies that a referral to the PSR may be made where it appears there is the possibility that a person may have engaged in inappropriate practice in the provision of services. It is ultimately for the director or a committee to investigate whether or not a person has provided services and to determine whether the conduct of the person under review in relation to the rendering or initiation of 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 debt and the administrative penalties for debt 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 resulting from the giving of false or misleading information. I thank the members for their contributions to the debate on this bill.

Michael McCormack (Riverina, National Party, Shadow Minister for International Development and the Pacific) Share this | Link to this | Hansard source

I rise to speak on the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2022. This bill amends the Health Insurance Act 1973, the National Health Act 1953 and the Dental Benefits Act 2008. In broad terms, the bill aims to protect the viability and ongoing integrity of Medicare, including the Medicare Benefits Schedule and Pharmaceutical Benefits Scheme.

I want to place on record that Australia has a world-class health system. If you travel anywhere in the world, you can see how good our health system is. It is first class. Can it be better? Of course, it can always be better. Can it be improved? Yes, indeed. But we should be very proud of the fact that our health system is what it is. Certainly under the coalition government we did everything we could to ensure our health system was enhanced in taking over from the previous Labor government. I acknowledge all of the efforts—new bills and new drugs that any government, current or past, put onto the PBS—because they save lives. They, indeed, save lives. Our provision of health care for all Australians is the envy of most nations.

But this is something we should never take for granted. We should make sure that we do everything we can to enhance it. When we were in government, we demonstrated our steadfast commitment to affordable health care for all Australians. We certainly did that in our nine years of government. I can remember the former health minister, the member for Flinders, being passionate about that. It was not just about health services and health care in Australia. During COVID-19 and the darkest days of the global pandemic—and we are still not out of it, by the way—there was the attention that he drew and the efforts that he made to ensure that Pacific island nations were looked after as far as vaccines, as far as health professionals and as far as making sure that we saved as many lives as we could.

I am staggered by the fact that some of those opposite often ask, 'What did we get for the debt we are now in?' I know that the media has changed its tune in some sectors about where we are now and where we were just two short years ago. Some people have convenient memory loss as far as the situation that we were faced with. I was in those meetings when Professor Brendan Murphy said that we could lose tens of thousands of Australians in a matter of weeks if we did not act. We did act, and we made sure we did everything we could to get the vaccines rolled out, to get Australian lives put first and foremost, because that is the first priority of government. So I know the minister opposite is keen to ensure that this government also does what it should, builds upon the record we had and ensures Australians are looked after when it comes to their health system.

I also know that with Medicare and certainly bulk-billing we need to make sure, particularly in regional Australia and particularly in remote Australia, that Australians are looked after. Obviously we'll do everything we can, and I know the members with me here, Braddon and Barker, being regional members, know too how important it is to keep our health system front and centre, because regional Australians often don't get the health services and indeed the health professionals that they enjoy in capital cities. So anything that can be done by a Labor government or by the provision of bills and by the passing of bills to improve the lives and lots of those who live beyond the bright lights of our capital cities we should and we will indeed support, because our opposition leader, the member for Dickson, said—as did the Nationals leader, the member for Maranoa—that if there's good policy and there is good legislation put forward, we'll not only consider it but help the government pass it. Indeed we committed through our budgets $133 billion over four years to Medicare, including $31.4 billion in 2022-23, an increase of $7.3 billion compared to the 2021-22 budget, and we had those commitments going forward. Medicare and the PBS form the cornerstone of Australia's universal health system—a health system, as I said before, we should be very proud of. We saw record investment as a government in Medicare, and that was important for healthcare services no matter where people lived.

This bill is drafted in almost identical terms to a bill introduced by the previous government in the 46th Parliament. It was not debated, and it lapsed upon dissolution of that parliament, prior to the 21 May election. This bill proposes to make a number of changes to the Commonwealth's health provider compliance program to strengthen the ability to recover debts owed by health providers who have engaged in inappropriate practice. We cannot have people engaging in inappropriate practice. I see the good member Dr Freelander up there, and I know he's going to speak next. I know how his constituents regarded his level of service when he was practising in his local area, and I commend him for the role that he played in that.

The most significant amendments include new sanctions and increased maximum penalties for body corporates and nonpractitioners. Overall the proposed amendments appear to be uncontroversial and unopposed by stakeholders, although stakeholders have continued to raise broader concerns about the intricate nature of the Medicare system for healthcare providers and the challenges of complying with Medicare obligations in some instances. Importantly, this bill is comprised of one schedule, which is divided into four parts, and I'll just go through those for benefit of the House.

Part 1 amends the HIA to provide for a number of amendments to the operation of the Professional Services Review scheme, including allowing the director of the PSR to enter into agreements with body corporates. Part 2 amends the HIA, NHA and DBA to clarify that a person or body corporate owing a debt to the Commonwealth may make only one application to the Administrative Appeals Tribunal with respect to a reconsidered decision or notice of assessment of shared debt determination, even when multiple garnishing notices have been issued in relation to that debt. Part 3 makes a number of amendments to the HIA, NHA and DBE to clarify the Commonwealth's debt recovery arrangements following the passage of the Health Legislation Amendment (Improved Medicare Compliance and Other Measures) Bill 2018. Finally, part 4 amends the NHA and DBA respectively to replace references in those acts to making a false or misleading statement with references to the giving of false or misleading information.

These are all important. I note that the HIA, NHA and DBA set out a legislative framework for the provision of claiming of services and benefits with respect to the three major public health funding schemes: the Medicare Benefits Schedule, the Pharmaceutical Benefits Scheme and the Child Dental Benefits Schedule. That is good, and that is appropriate. I again place much importance on child dental appointments that parents should make. Before I became a parent, and certainly when I did become a parent, my mother always said to me that, if you look after your child's feet and if you look after their oral health, then the rest of it just about takes care of itself. That is important: put your kids in good school shoes, take them to the dentist every year and you can't go too far wrong. My mother, as always, was correct.

The Medicare GP bulk-billing rate in the 12 months to June 2021, interestingly, was 88.8 per cent, up from 82.2 per cent in Labor's last year, that being 2012-13. I appreciate times change and practices alter, but it should be noted that that is a 6.6 per cent increase on what the Labor government achieved. And that is to be commended. That is a feather in our cap, when we were government. More than 152.2 million bulk-billed GP services were delivered in 2020-21. That was 46.4 million more than Labor's last year, in 2012-13. Sometimes those on this side get a bad rap when it comes to these things, but those figures do not lie; they tell a story. They tell a story about our commitment to a world-class health system. They tell a story about our commitment to Medicare GP bulk-billing and to making sure that GPs can offer that service and are doing well enough to survive and keep their doors open, particularly in rural and regional Australia.

Just last Friday I turned the first sod on the rural medical school in Wagga Wagga. That follows on from successful rural medical schools in other parts of regional New South Wales and Victoria, and that is going to make such a difference for the young people—and some not so young—who want to become GPs and want to do their training in a regional setting. If you train people from end to end, from start to finish, in a regional setting, chances are you'll keep them in that regional setting. Charles Sturt University, which is partnering with Western Sydney University in the rural medical school at Orange for their courses, generally claims that between 70 to 75 per cent of those students right across the spectrum of the course offerings they provide—given they are doing the tertiary education in a rural setting, whether it's Albury-Wodonga, whether it's Wagga Wagga or elsewhere—do actually stay in that regional setting. And they have an equally wonderful veterinarian course across the university's broad spectrum of offerings.

When I was Deputy Prime Minister, that was the first act I did—to make sure that rural medical school network was established. It's going to make such a difference. Already more than 20 students are at that UNSW course in Wagga Wagga. When they get the new three-storey building with the research and the educational components, it's going to make the world of difference. It's almost one of those cases of build it and they will come. If you build not only the right infrastructure but also the right services, put in place the right provisions in regional Australia, you'll get young people doing their medical training there and then staying there. It is so important.

That facility will open next year. It's not only going to be important for Wagga Wagga; it's going to be important for those smaller regional communities outside of even the Riverina electorate—places such as Deniliquin, Finley and Hillston and other areas that I do not represent. That's not what this is about. As a member of parliament, certainly a regional member of parliament, I should always be fighting for those services to be given to regional areas, because, my goodness, they do need them.

In the coalition March budget this year, we provided $66 million towards deregulating and expanding access to Medicare funded magnetic residence imaging, MRI, services in regional and—particularly importantly—remote Australia. We strengthened Medicare by making telehealth consultations permanent. That is a good thing. I don't ever want to see telehealth taking over wholly and solely from face-to-face appointments, because often general practitioners and other medical specialists need to see patients right in front of them to give them the correct diagnosis. But, certainly, during COVID lockdowns and the situation with remoteness, telehealth became very, very important.

In the Riverina and Central West region, there have been more than 400,000 telehealth consultations funded through Medicare since the start of the pandemic. I thank people for their patience and for taking up this wonderful technological advancement. But I also thank the telehealth medical specialists, whether they're in a regional centre or a capital city, for being on hand to provide those services. In the year leading up to the March 2022 budget, the coalition government funded 2,414,195 free or subsidised medicines in the Riverina through the PBS. I know what a difference this made for long-term, long-time sufferers of debilitating illnesses. It makes such a difference when they can get that drug freely or when it is cheaply available to them. It changes their lives, and it changes their family's life.

During the coalition's time in government, we made nearly 2,900 new or amended medicines listings through the PBS, and we should be congratulated for that. This is important proposed legislation, and I'm glad it's been brought to the House by the minister.

Mike Freelander (Macarthur, Australian Labor Party) Share this | Link to this | Hansard source

I'd like to thank the minister for bringing this proposed legislation to the parliament through the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2022. It is important legislation, as has been noted. I'd also like to thank the member for Riverina for his kind words, and I understand that his community for some time has struggled to get access to high-level care and even primary care. He recognises, in an equitable manner, the importance of health care for his community and for the wider Australian community.

This bill is not by itself controversial. It strengthens the government's compliance powers with respect to inappropriate practice by corporations and improves the debt recovery process. It amends the Professional Services Review arrangements to manage and review the practice of corporations, not just single practitioners.

I think it's very important to look at the history of our national health insurance scheme to understand the Medicare compliance issues that have been made very prominent by the Nine newspaper group and media company's investigation. It's very important to understand that this is actually a system problem that relates to the history of the development of health services in Australia and the changes that have occurred in the last several decades. Medicare was based on the Whitlam government's first national health insurance program, Medibank, which was developed by Scotton and Deeble in the mid-1960s. Essentially, we are using the same system now that was developed in Australia in the 1960s.

Of course, Medibank was removed by the Fraser government, and Medicare was introduced by the Hawke Labor government in 1984. In fact, I started my private medical practice in February 1984 in the same week that Medicare became available. For almost 40 years, my income relied on Medicare, and the process was very important to me. It meant that people in my community who had previously not been able to access care by a paediatrician or had been put on long waiting lists and sometimes missed out on accessing care could see a paediatrician, a general practitioner or other specialists in an equitable manner for themselves and for their families. It was a revolution, an absolute revolution.

Prior to 1984, the commonest cause of bankruptcy in Australia were medical costs. It's important to understand that Medicare changed that dramatically. It made a big difference to the ability of people in my community to access primary care and high-level care, and it was, as I said, a revolution. Practices changed over time, and in the last 10 years changes in illness patterns, changes in bulk-billing rates, changes in rebates have made our system much less equitable. There's been a collapse of the public hospital outpatient systems. Waiting lists now are sometimes measured in years, not months, and once again people are really struggling to access primary care.

The system is not designed to deal with the current age of chronic illness and an ageing population, so people are forced into non-compliance. Does fraud occur? Of course it does. This is a $50-billion scheme, and some people will not do the right thing. But those numbers are very small. Practitioners are almost forced into non-compliance with a scheme that doesn't deal with chronic illness, doesn't deal with patients with multiple system disorders, doesn't deal with the time it takes to deal with the social determinants of health—things like housing, medication costs, family issues, education. The medical system is not designed to deal with all these issues.

I think that I am probably the only member of the House of Representatives or the parliament that really lived on Medicare repayments. I had a very high bulk-billing rate in my practice and tried to provide timely access to care for all of my patients, so I understand the system. We were subject to compliance checks—as we should have been—by regular review. I have never had a practice management review put in place because we spent a lot of time in my practice dealing with compliance issues, making sure we were billing appropriately, making sure we were not overordering pathology or radiology but rather working within the parameters that Medicare outlined. I think that is true for the vast majority of my colleagues.

The Australian public of course has a right to know that every health dollar that they spend, or the government spends on their behalf using their taxes, is spent in the most efficient manner, and this is timely legislation because the other change that we've had in medicine over the last couple of decades is the increasing corporatisation of medicine. I worry about that a lot because often the publicly listed medical corporations have links to pathology providers, to radiology and imaging providers and to other health systems such as private hospitals et cetera. Again, that introduces a more complex addition to the simple visit to the local doctor. Many people that I see in my community do not have a general practitioner that they can name, and a recent survey at one of the public hospitals in my electorate's emergency department showed that almost 35 per cent of people presenting to the outpatient department didn't have a GP that they could name, and even more used the emergency department as their general practitioner. That's put enormous pressure on our health system.

One of the reasons is that the Medicare rebates were frozen by the previous government. Admittedly, it was started as a short-term measure by the Gillard Labor government to run for 12 months. This was extended to run for 10 years by the previous government. That has meant Medicare rebates have become less and less of the billing fee, which has meant there has been a disincentive for people to bulk bill and a disincentive for patients to see a general practitioner charging private fees, putting more pressure on our public hospital system. We know that our public hospital system has been under enormous pressure during the pandemic and afterwards.

We also know that recently there has been real difficulty in getting medical students to train as general practitioners. Partly that relates to income, but it also partly relates to quality of practice and lifestyle. We need to look at ways we can encourage more people into general practice, which remains the cornerstone of our health service.

It's great to have fellow medical practitioners in the House today: the member for Mackellar, a very experienced general practitioner; the member for Kooyong, a paediatric neurologist; the member for Robertson, an emergency doctor. It's great to have them here, and I think they will provide some extra insights into this legislation.

I would say that, whilst this legislation is important, it is even more important in this day and age to see this as a system problem and to see how we can refit the Medicare system to deal with the age of chronic illness and an ageing population. We've also heard talk of medical students being enlisted by the New South Wales government to work in hospital situations to provide some extra manpower. I think that's a good thing. It's good for the medical students, and I think it's good for our system.

We've also heard of trials using pharmacists to prescribe for certain conditions, and I have no problem with that. I think that it is important that everyone in the health system works to the maximum scope of practice. But I also see huge difficulties within the pharmacy system with restrictions on practice and restrictions on prescription, where people who may have been on medication for 20 years have to go into a pharmacy every month to get a repeat prescription. This is wrong; it's very inefficient. It puts extra costs in the system and I'm sure could be modified to make our system even more efficient.

I think there are many ways that we can improve our health system if we look at how the health system itself deals with the new age. There are many issues also in our dental scheme, which is only very partially applicable. It's leading to severe inequalities in access to dental care: No. 1, particularly in children—my own specialty—but also in the elderly. Many elderly people have difficulty with nutrition, partly at least because of a lack of access to adequate dental care. Our system needs to be modified to deal with this.

As I've said previously, there is this tie-up with corporate medicine and pathology and radiology. I think that adds another possible area of difficulty within the system that needs to be really examined in close detail.

We've heard from previous managers of the Medicare compliance section. Dr Tony Webber, who I know very well, is a very honourable and a very experienced general practitioner who has raised concerns about compliance issues with Medicare, and we would be right to listen to his concerns about this. The previous manager of the compliance system, Professor Julie Quinlivan, has also given some very good information about how the compliance system could be improved.

From my point of view, as a still-practising paediatrician, the Medicare system has been vital to providing equitable care across our greater Australian community. Unfortunately, times have changed, illness patterns have changed and the delivery of health care has dramatically changed.

There have been remarkable advances in digital medicine. I recently saw a digital stethoscope that can be placed on the patient's chest. It can do an ECG and record the heart sounds.

This can all be transmitted remotely to the computer or even the phone of a GP or specialist. This is another remarkable advancement, and another way of looking at how we can best manage the telehealth system, which has been really important. We were more or less forced into it by the pandemic, but I think it is really important that we take full advantage—particularly in outer metropolitan, rural and regional areas—of the telehealth system, which should be expanded. We also need to see what advances can be made in keeping people out of hospital and managing their illnesses at home. There's much to be said for the hospital and home type of system, with better systems of managing things like heart failure, respiratory infection, asthma, diabetes and a whole range of different illnesses that can be safely managed at home with appropriate resources. It's really important for us as a new Labor government to make sure we take full advantage of these new advances.

Our electronic health records in Australia are so far behind the rest of the developed world. We really need to look at how we can improve our digital health records and make sure that we take full advantage of the cost savings and the efficiencies that would cause. We should try to update our systems so they are all compatible across private and public medicine, across our hospital system, and among general practitioners. I commend this legislation, but it is only part of the job. I know that the Albanese Labor government will continue the changes in health care that we need to deal with our ageing and growing population.

Gavin Pearce (Braddon, Liberal Party, Shadow Assistant Minister for Health, Aged Care and Indigenous Health Services) Share this | Link to this | Hansard source

I acknowledge the previous speaker and his service that he has provided over a lifetime. In fact, to all of those in the chamber from all sides, I recognise your contribution to the medical fraternity this afternoon. I rise to speak on the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2022. The bill amends the Health Insurance Act of 1973, the National Health Act of 1953 and the Dental Benefits Act of 2008. In broad terms, the bill aims to protect the viability and ongoing integrity of Medicare, it includes the Medicare Benefits Scheme and Pharmaceutical Benefits Scheme.

Australia has a world-class system. Our provision of health care to all Australians is the envy of most nations. But this is something we should never take for granted. Medicare is something that we must protect. The Liberal and Nationals government demonstrated our steadfast commitment to affordable health care for all the Austrians during our nine years in government. Even during the most significant economic and health crisis that our country has seen in over 100 years, our commitment to provide health services that Australians expect remained resolute. The coalition was able to continue to invest in our nation's health services, even during dire economic headwinds, because our economic response to COVID and the pandemic was also world-leading. In March, the coalition delivered the largest and fastest improvement in the budget bottom line in over 70 years, and this improvement allowed us to commit to the largest investment health services in history. This was demonstrated through our ongoing commitment to Medicare.

The Liberal and Nationals government was committed to investing $133 billion over four years in Medicare, including $31.4 billion in 2022-23—an increase of $7.3 billion compared to the 2021-22 budget. We committed $32.3 billion in 2023-24, $33.9 billion in 2024-25, and $35½ billion in 2025-26. The coalition oversaw record investment in Medicare. Importantly, this investment ensured that all Australians had access to healthcare services, no matter where they lived, whether they lived in the city or the bush, and no matter how old they were.

Medicare and the PBS form the cornerstone of Australia's universal health system. Medicare provides free or subsidised access to most healthcare services for all Australians. The Pharmaceutical Benefits Scheme, PBS, delivers affordable life-saving medications to all Australians. In fact, in our term of government, we delivered around 2,900 new or amended listings on the PBS at an overall investment of around $16½ billion. Where I live, we used to call it the 'PB-Yes' rather than the PBS. The coalition's commitment to list every recommended drug ensured that Australians had access to affordable, life-saving medications that would otherwise cost thousands or sometimes hundreds of thousands of dollars without the PBS subsidy.

In relation to the bill, this supports the integrity of the Medicare Benefits Schedule, the Pharmaceutical Benefits Schedule and the Child Dental Benefits Schedule by addressing inappropriate practice, protecting payment integrity, encouraging compliance with claiming requirements and supporting consistency. This bill is the same legislation introduced by the former coalition government, in the 46th Parliament, by the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2021. That bill was not debated and it lapsed upon dissolution of the parliament. Our bill reflected the coalition's commitment to protecting the integrity and financial viability of Medicare, ensuring that all Australians had access to our world-leading health system.

I want to acknowledge our hardworking, dedicated health professionals, as I did at the beginning of my address. They work tirelessly to continue to provide the care our local communities so desperately need. That care is often given in the face of enormous challenges whilst, in the vast majority of cases, much more than they can ever be remunerated for. There are a very small number who do not. I acknowledge that sometimes oversights and administrative errors occur. I want to assure our healthcare sector and all those hardworking folk I just described that this bill is not striving to correct minor oversights.

We must be careful, in this conversation we're having right now, that we don't paint every hardworking general practitioner with the same brush. In fact, our government had a strong track record of supporting hardworking healthcare professionals and peak bodies to correctly claim healthcare payments, with a clear focus on education, engagement and consultation. But we need to weed out our fraudulent or abusive practitioners who take advantage of our nation's Medicare system. Australians rightly expect that their hard-earned tax dollars are being used appropriately and effectively, particularly when they are spent in our health system, which is facing increasing pressures. To safeguard the ongoing viability of Medicare, however, we must ensure that our compliance system is rigorous enough to identify those who choose to abuse the system. We must protect, at all cost, the integrity of the Medicare system.

The primary intention of the bill is to strengthen the compliance and powers of the Professional Services Review, the PSR, which is the agency responsible for reviewing and examining possible and appropriate practices relating to Medicare or the PBS, and add a degree of flexibility to the PSR's ability to address any inappropriate practice or practices. The bill proposes to make a number of changes to the Commonwealth health provider compliance program to strengthen the ability of the Commonwealth, to recover debts owed by healthcare providers and those who have engaged in inappropriate practice.

The most significant amendments include new sanctions and increased maximum penalties for body corporates and non-practitioners. The bill comprises one schedule that is divided into four parts. Part 1 amends the HIA to provide for a number of amendments to the operation of the Professional Services Review scheme, including allowing the director of the PSR to enter agreements with body corporates.

Part 2 amends the HIA, NHA and DBA to clarify that a person or body corporate owing a debt to the Commonwealth may only make one application to the Administrative Appeals Tribunal with respect to a reconsidered decision or a notice of reassessment or a shared debt determination, even when multiple garnishees notices have been issued in relation to the said debt. Part 3 makes a number of amendments to the HIA, NHA and DBA to clarify the Commonwealth's debt recovery arrangements following the passage of the Health Legislation Amendment (Improve Medicare compliance and Other Measures) Bill 2018. Finally, part 4 amends the HIA, NHA and DBA to replace references in those acts to making a false or misleading statement, with references to the giving of false or misleading information.

In conclusion, it's one of my greatest privileges to regularly meet with representatives of our great healthcare sector. They are always willing to take on the heavy lifting. They are always there in our time of need. Over the past three years we've called on their services like never before. Day in, day out they have been there on the front line of the COVID pandemic. Their dedication cannot be overstated or repaid, and it is important to note that this bill in no way impacts our incredible health providers who are practising legitimately. I want to recognise that most are going above and beyond to provide the level of care that their patients so desperately need, often forgoing their own full wage or personal time in order to deliver that care.

But we must be continually mindful of further burdening our already overstretched healthcare providers with additional regulation or complexity in an already complex Medicare system. Therefore I acknowledge and welcome the government's commitment that they will continue to support the coalition provided practitioners and healthcare organisations who comply with their obligations, with a focus on education as well as ongoing engagement with peak bodies. However, where benefits are incorrectly or fraudulently paid, it is vital to the public interest that the Commonwealth expenditure is protected and that those debts are recovered. This will support further investments in health initiatives that all Australians will benefit from.

Once again the Albanese Labor government is demonstrating its commitment to passing copies of coalition legislation. In doing so the government has recognised that the coalition were leaders when it comes to this important healthcare policy and improving the sustainability of Australia's world-class health system for the benefit of all Australians. The opposition will support the passage of this legislation.

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

I rise to speak to the Health Legislation Amendment (Medicare Compliance and Other Measures) Bill 2022 as a relatively new member of this House but also as a medical clinician with long professional experience of Medicare. This amendment in and of itself is appropriate. It's not particularly consequential, but my concern is that it reflects several aspect of the systemic malaise of our public healthcare system. Many of these aspects were spoken to earlier by my friend and colleague the member for Macarthur. I wish to take the opportunity to note my concerns in the House today. Medicare is an extraordinarily important part of the Australian healthcare landscape. The fundamental principles of the Medicare system are true to what the Australian people want, need and deserve: universality, shared Commonwealth and state responsibility for public hospital care and a universal insurance against medical costs, including via bulk billing.

The Health Insurance Act, National Health Act and Dental Benefits Act set out the legislative framework for the provision and claiming of services and benefits with respect to all three of our major public health funding schemes: the Medicare Benefits Schedule, the Pharmaceutical Benefits Schedule and the Child Dental Benefits Scheme. The Medicare Benefits Schedule is Australia's most important health insurance scheme. It subsidises the cost of selected medical services for eligible patients provided by eligible practitioners.

Under the PBS, the Australian government subsidises the cost of medicine for most medical conditions. Services Australia administers MBS, PBS and CDBS on behalf of the health department and makes its payments. The purpose of the Professional Services Review scheme is to review and investigate the provision of services by practitioners and to determine whether those practitioners have engaged in inappropriate practice. To overcome issues with inappropriate billing for services, this parliament has already in recent years passed three other bills aimed at improving health provider compliance arrangements. These were the health legislation amendments of 2018 and 2019 and the Health Insurance Amendment (Administration) Bill 2020.

The bill before us today includes a single schedule divided into four parts, which includes several amendments to the Professional Services Review scheme, changes around appeals to the Administrative Appeals Tribunal and revisions to the Commonwealth's debt recovery arrangements for the HIA, the NHA and the DBA. Put broadly, the intent of this bill is to extend the scope of the Professional Services Review to enter into agreements with corporate entities and to ensure consistency across the health administration sector on the Commonwealth's debt recovery processes and in relation to the giving of false or misleading information.

We all know that the Medicare system is not perfect. In the 2018-19 financial year, the Australian National Audit Office reported that Health recovered $49.3 million in claims which should not have been paid and $123 million in estimated savings through changes in the claiming behaviour of providers. All principled medical professionals will support measures aimed at preserving the integrity of Medicare and optimising the use of our limited healthcare resources by preventing wrongful claiming.

There are, however, concerns which have been expressed by the Royal Australian College of General Practitioners amongst others about the proposed procedural fairness and the transparency of this expansion of the PSR scheme as proposed in this bill. Firstly, this bill proposes that the director of the PSR should be able to enter into agreements with non-practitioners and bodies corporate. While most general practices are privately owned by GPs, there are many other ownership models, including shareholder owned, publicly listed companies.

This government needs to have different regulatory expectations of corporate entities of varying sizes and resources as compared to smaller individual practices. There is with this bill a real risk of increased compliance burden on smaller practices, particularly in rural areas, which could reduce the capacity for those doctors to provide high-quality care to patients while their practices are under investigation.

Similarly, the increased penalties in this bill for the refusal or failure to produce documents or information suggests a focus on cost recovery and punitive approaches to compliance, which may exacerbate existing concerns in the profession about the intent of compliance activities. Expansion of the power of the director to publish information about a person who has not fulfilled their obligations under a section 92 agreement is a breach of privacy which could have a significant impact on individual practitioners. The increase in sanctions and the broader debt collecting powers prescribed by this bill reflect a really punitive approach to compliance, rather than an educator focus helping practitioners to bill correctly.

The truth is that anyone who has engaged with this process will tell you that Medicare billing is extremely complex. There are innumerable legal instruments around Medicare billing. These add up to more than 7,300 pages of acts, regulations, determinations, rules, directions, terms and conditions, schedules, website pages and guides. This excludes private health insurance medical fee schedules, the state and territory health acts, the contents of the MBS Online website and various other sources.

Feedback from GPs tells us that increased Medicare compliance activities and the fear of being audited are distracting them from their primary focus, which is and should always be the delivery of high-quality, patient-centred care. This fear creates a significant conflict between the administrative obligations that GPs need to adhere to, as set out by this legislation, and their commitment to patient care.

GPs are the foundation of our healthcare system. General practice provides 177 million services a year to approximately 24 million people in Australia. There has in recent years been unprecedented demand for healthcare services as our population ages and rates of chronic disease and psychological stress increase. Hospital and emergency department demands continue to skyrocket, resulting in ambulance ramping, suboptimal healthcare delivery, poorer patient outcomes and increasing secondary and tertiary health expenditure. Decades of significant underfunding and cost cutting have left our general practices on the verge of collapse. Almost half of our practising GPs have indicated that it is no longer financially sustainable for them to continue working in general practice. The proportion of bulk-billed GP services recently dropped for the first time in two decades. Experts predict a shortfall of 11,390 GPs, or almost 28 per cent of the GP workforce, by 2032. Medical student interest in general practice as a career is now at a low of just 13.8 per cent.

The COVID-19 pandemic, recent natural disasters and the health and mental health issues resulting from them have compounded these issues, highlighting the gaps and inequities in the current delivery of primary care, exacerbating workforce burnout and draining resources within general practices. It was a peculiar, cruel insult that the previous government did not consider GPs to be frontline workers, although they were in the vanguard of the COVID-19 pandemic response. In addition to the increasing costs of living, out-of-pocket costs for patients accessing their GPs have increased by 48 per cent in the past decade, reflecting how Medicare patient rebates have failed to keep pace with the growing cost of delivering health care. We need to support our GPs. We have to make general practice more attractive to medical graduates.

We need to stop accusing overworked, often underpaid professionals of widespread systemic abuse of the Medicare system. There have been recent claims of widespread Medicare abuse by doctors and other healthcare providers made by the Sydney Morning Herald, the Age and the ABC which suggest that the realities of ambulance ramping, public hospitals not coping and general practices being in tatters are all due to doctors defrauding Medicare. In fact, instances of proven Medicare fraud are minuscule. The most recent report of the Professional Services Review itself found fewer than a hundred instances of proven inappropriate practice in 2020-21. The sum total of these ill-gotten gains, all of which was recovered, was $24 million, a far cry from the fanciful $8 billion claimed by a gotcha media culture concerned less with the truth than with a cheap, demeaning headline.

In fact, a recent Healthed survey confirmed that most doctors actually deliberately underbill. More than two-thirds of doctors surveyed underbilled most days. GPs, especially female GPs, spend as much as 14 per cent of their time on non-billable activities. These non-billable activities include patient care, arranging tests, arranging referrals, consulting specialists, talking to allied health professionals, renewing medications and providing advice and education. If the true cost of under-billed services was included in this accounting, the figures would show that in fact Medicare is rorting our GPs, so we should not be surprised, when our GPs were asked about the impact of that recent media coverage on their view of their own practice, that they described it as soul-destroying, disappointing and insulting. Many felt that the conflation of unintentionally incorrect billing, mostly due to very understandable confusion about Medicare rules, with intentional rorting was a very serious flaw in the media representation of why Medicare is failing GPs and the public. I received a letter from a GP in my own electorate of Kooyong that called these claims 'damaging' and 'sensationalist'. He said that he will continue to be 'scared to bill appropriately for fear of appearing to rort the system'.

The amendment we're debating today is a small thing. It's just a tinker on the edges of a very large problem. There seems to be no appetite or vision from this or other governments for what we need, which is large-scale generational reform of our healthcare system. Medicare is 50 years old. We need our federal government to work with our states and territories to provide better primary care across our jurisdictions. We need to prevent health care from being just another political football between the federal government and state jurisdictions. We need to protect our GPs. We need to treat them with respect, not suspicion.

We need Medicare—that wonderful universal scheme—to be better, smarter, more generous and more suited to the 21st century. We need to stop tinkering around the edges. We need a better and clearer vision of what we can achieve together. I commend this bill to the House.

Rowan Ramsey (Grey, Liberal Party) Share this | Link to this | Hansard source

Last Friday was an anniversary for me and a number of other people in this place, including the member for Parkes, who is sitting in front of me. We've been here for 15 years. For the entire period that I've been here, I have been on about the disparity in health services between regional and rural areas and the city. Despite enormous effort—I note the member for Kooyong's comments, and I'm not suggesting here that there is large-scale Medicare fraud—there are some very low value medical services being offered in places. We know Medicare item numbers are accessed in the city at double the rate they are in the country. I'm not saying for one instance that we need twice as many doctors in the country as we have now, but I guarantee you that we need more. I would also say that, on the other hand, there are definitely more services. Medicare is being debited more often in the city than it should. That's not to say the service is a fraud. But is it really necessary? That's a question that I think we have to deal with.

In the 2018-19 budget, the coalition put the 10-year, $550 million Stronger Rural Health Strategy in place. I understand it delivered 700 extra GPs and 700 extra nurses in the first two years. Out where I live, you'd have to ask where they are—but I'm told those are the numbers—and it's getting worse. We've had a plethora of programs designed to address this issue of GP under-servicing in the country. We have the Rural Health Multidisciplinary Training program, and the 2019-20 budget delivered $62 million to establish and deliver the National Rural Generalist Pathway as well. We have the Australian General Practice Training Program and the Rural Junior Doctor Training Innovation Fund. We've injected $65 million into the rural bulk-billing incentives, which started in January this year. The Workforce Incentive Program, of around $390 million per annum, provides incentives to deliver primary healthcare services in rural, regional and remote Australia. We have the Rural Health Outreach Fund and the Rural Locum Assistance Program.

All of these programs are in the tens of millions of dollars, and I'm here to tell you that the services in the country are still going backwards. It's not through a lack of trying, a lack of effort or a lack of money, but, somewhere along the line, the programs aren't hitting the spot and aren't attracting enough doctors to the country. Not only are they not attracting enough doctors into the country but also they're not attracting enough doctors into GP services—into a GP specialist service, if you like.

I come from the north-eastern Eyre Peninsula. There are five major towns across the northern Eyre Peninsula—Streaky Bay, Wudinna, Kimba, Cleve and Cowell—with an estimated total population of about 7,500. Currently, we have three full-time-equivalent resident doctors, so that is a ratio of about 2,500 to one. I heard some news on the weekend—some bad news, I'd have to say—and I rung up the community where the doctors live. Two of them have announced that they are leaving. That will leave us with one doctor for 7,500 people. I would say that is worse than a crisis; that is an absolute train wreck.

SA Health is trying to fill the gaps with locums. They are way too expensive. Locums can be paid up to $3,000 a day, way beyond what a local resident practitioner would get. We need to get more local practitioners on the ground to address this bleed-off of health funds. There's another problem with locums. God bless them. When I need one, I go to them and I am very grateful that they are there. But it would be fair to say that, if I had a long, ongoing illness, it would be impossible to build up a familial link to that doctor. Every time you go to a new doctor, you have to explain your situation again. Is there any real incentive for a locum to get to the bottom of what is a long-term, difficult issue? It is so much easier to flick it down the road, quite frankly.

I'll come back to the Medicare items and the fact that they are accessed at double the rate in the city to what they are in the country and how we need to do something about it. In 2019, I convinced Greg Hunt that it would be a very good idea to come to South Australia. We did a series of workshops around the Grey electorate. When we came to Eyre Peninsula, in Kimba, my hometown, he met with the Northern Eyre Peninsula Health Alliance. That was September 2019. Disturbed by the severity of the problem, he left $300,000 on the table for NEPHA to come up with a solution built from the ground up. That report was delivered to Greg Hunt in the early weeks of this year. He was very impressed. He said it was the best report he had ever seen developed by a local community to try and address their own problems. But it required a state contribution and, in the way of elections and our democracy, we hit the South Australian state election first and then we had the federal election and we didn't manage to land a deal between the two governments before we went into caretaker mode.

I gave that report to Minister Butler soon after he was appointed health minister, and NEPHA also sent him a copy and requested a meeting. I have written to Minister Butler. I've spoken to Minister Butler. Six months into the job and he has still not found time to meet with this organisation that was provided with $300,000 of public funds to come up with a solution to a problem where we are now facing down the barrel of 7,500 patients to one doctor. I'd say that's an emergency, and the health minister, who's from South Australia, needs to get himself acquainted with this good mob of people from South Australia to discuss the issues on Eyre Peninsula, which I think are at the pointy end of the stick of doctor shortages around Australia.

We had a restricted pipeline through the early 2000s and it led to the situation where we were importing a lot of doctors into Australia. It was one of those things where the choke was kept on too long after the overservicing of the 1990s. But, in any case, numbers have ramped up again. They're turning out about 4,000 a year. There are 30,000 GPs or thereabouts practising in Australia. With 4,000 a year, even if only half of them wanted to be GPs, that should be enough to backfill the problem, to fill up the shortage. But we are finding that less than 15 per cent of medical graduates actually want to become GPs. Why is that? We could talk about status. We can certainly talk about money. If only 15 per cent of medical graduates want to become GPs, it stands reason to me—and I did maths at my rural school—that means 85 per cent of them want to be specialists. How is it that there can be enough money in the Medicare system to support 85 per cent of those graduates to go on and become specialists, unless something is going wrong in the payment system? That's why I support this legislation. Maybe it doesn't go far enough. I'm not saying that there is widescale rorting going on, but there is certainly the misapplication of public funds, because we are funding services and overservicing where we don't need them. We don't need 85 per cent of our medical graduates becoming specialists. It would be a far better ratio if, in fact, we had 85 per cent wanting to be GPs. Even 50 to 50 would be a huge improvement on where we are. That over specialisation, that referral system that sits within our medical system at the moment, is a complete drain on taxpayers' funds and it is a waste of money. There is a whole lot of low-value medicine going on here, and, if we're going to actually do something about this shortage, which is delivering one doctor for every 7½ thousand people, we're going to have to get to the nub of those problems.

Just to reiterate, we couldn't be in this position unless there was financial incentive for it to occur. As we know, most of the money that is earned in the health sector comes from the Medicare system. It draws and holds GPs to the city for lifestyle reasons. It's enticing medical graduates into the specialist stream for reasons of finance—and perhaps prestige and working hours. Either way, we need a workforce that is fit for duty. We need to fashion this workforce completely differently, and I don't think we can do it unless we attack those fundamental levers which are providing the financial incentives in the system. In this case, this bill is about making sure there is less illegality in the system. I hope it also goes the distance to inquire where and how taxpayers' dollars are being spent and if they can be spent more appropriately to bring about a fairer result.

Ged Kearney (Cooper, Australian Labor Party, Assistant Minister for Health and Aged Care) Share this | Link to 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.