Rachel Siewert (WA, Australian Greens) Share this | Hansard source

The Greens support the need to ensure the integrity of the public revenue expended on Medicare services. Expenditure on the Medicare scheme was over $14 billion in 2008-09 and it has grown by more than a billion dollars per annum over the last two years. We believe that compliance audits are necessary checks to confirm that a medical practitioner was eligible to provide a Medicare service, that the service was actually provided and that it met the requirements of the Medicare item paid in respect of the service.

We understand that, at present, many practitioners voluntarily cooperate with Medicare Australia during compliance audits; however, on average, 20 per cent of practitioners either do not respond or refuse to cooperate with a request for documents. When this occurs, Medicare Australia does not have the authority to require the production of relevant documents and cannot confirm that the Medicare payment is correct. The Greens believe that health reform has to be underpinned by a greater understanding of health needs, and we believe that payments should be monitored and measured by their relevance to patients’ needs, not those of the provider and the number of services they are willing or able to perform. We believe that this particular process can fulfil a number of requirements.

In 2007-08, 81,224 providers generated nearly 280 million MBS services. New groups of practitioners, such as allied health practitioners, are also now able to provide Medicare-eligible services. It does not seem unreasonable for the taxpayer to want to be sure that the services being paid for are audited. In 1996-97, the Australian National Audit Office found that non-compliant MBS payments equated to around 1.3 to 2.3 per cent of expenditure. According to the National Audit Office, this suggests that current levels of annual non-compliant payments could be at least $170 million to $300 million per annum—a not insignificant amount of money.

The Greens believe that requiring providers to verify their claims when there are specific concerns about the claims is in fact a reasonable and responsible way of protecting the public purse. We agree with the view of Medicare Australia that the consequences of not having a penalty system for non-criminal acts resulting in incorrect claims is that providers can repeatedly make incorrect claims with little or no adverse outcome other than possibly having to repay moneys specifically identified as having been incorrectly received. Similarly, the Greens accept the view of the Department of Health and Ageing, which has argued that the key risks to the integrity of the Medicare scheme need to be addressed by establishing a simple, cost-effective administrative mechanism to deal with incorrect Medicare payments, which constitute a significant risk to Medicare expenditure.

The debate here is about potentially conflicting public interest principles. There are the interests of Medicare consumers in the maintenance and integrity of the health system and the public interest in the confidentiality of the communications in the doctor-patient relationship and the medical records of the patient. The Public Interest Advocacy Centre has proposed changes that would appropriately balance the public interest in the integrity of Medicare and the public interest in the maintenance of public confidentiality and privacy of health records.

This issue took a considerable amount of time at the hearings of the committee inquiry looking into the Health Insurance Amendment (Compliance) Bill 2010that is, confidentiality and, obviously, the need to access records to verify them. I note that, during the Senate inquiry, the Consumer Health Forum of Australia stated that they do not believe that privacy would be compromised under the changes outlined in the bill. They say that consumers are fully aware of the need to ensure a sustainable health system that has checks and balances in place. It is entirely in the public interest for the MBS compliance procedures to be implemented. As outlined previously, the Greens understand that Medicare Australia is working on guidelines to look at the sensitivities around privacy, and we welcome this. We are pleased to see that the government has included a provision that medical advisers should have oversight of all audits.

This issue is further complicated by the health services amendment bill which has been introduced into the parliament and which also deals with the issue of electronic records and how Medicare can access patient records for clinical and non-clinical information. Since that bill was first introduced into the parliament things have been moving on, and I have been trying to look at this bill in light of the other bill that we will be dealing with in the not-too-distant future, which is currently the subject of a committee inquiry. Having said that, having another bill that makes further changes makes the bill we are currently debating a little bit more complicated for us. Obviously we need to go back to the other bill and ensure that it is consistent with this bill.

We believe that these records need to be carefully handled. While we accept what the Consumers Health Forum says around consumers knowing and appreciating the fact that there needs to be some sort of compliance process, I have had phone calls from consumers and I know that they are concerned about the release of clinical records. Therefore, while consumers are supportive of the auditing process, we also need to make sure that we do have measures in place to protect people’s privacy. The Greens are pleased to see that the government picked up on a number of the amendments suggested by the Senate inquiry and that they have been incorporated into the bill, which we think goes some way to addressing the concerns that were raised during the Senate inquiry. It has been suggested to us that there could be a two-stage process in looking at electronic records. Firstly access to information that is not clinical records could be looked at and then subsequent decisions could be made if there needed to be further detail.

During the inquiry the issues were also raised of who did and did not get access to records, how easy it was to access electronic records and whether the process of accessing electronic records would be made easier. The point was made that some doctors still do not have electronic record and data collection. It would make the process a lot easier if all doctors had electronic data collection and if that was in fact mandatory; however, the government has not gone that far. We have decided we will not move subsequent amendments to this bill, because the government has picked up on some of the recommendations.

The Greens will continue to monitor the way the government puts in place measures to protect patients’ privacy. Unfortunately, we have already seen some examples where patient records have been inappropriately accessed. We want to ensure that does not happen. We appreciate that we need to find a balance and we are looking at the next bill to ensure that that balance is maintained. We appreciate the fact that the government is taking on board, as is Medicare Australia, the issues around privacy and trying to find that balance. We will monitor that closely. We will support this bill, but we will continue to observe and monitor implementation closely.