Jordon Steele-John (WA, Australian Greens) Share this | Hansard source

I'm speaking to the Health Legislation Amendment (Improved Medicare Integrity and Other Measures) Bill 2025. As I understand it, this bill has been presented to the parliament following the independent review of Medicare integrity and compliance. This review, with its final report delivered in 2023, provided observations regarding fraud, non-compliance and vulnerabilities of the payment system. It called for the focus to remain on the structural issues and controls in the system to build trust in Medicare and materially reduce non-compliance and fraud. The review found significant changes are required to ensure usability and practitioner compliance. I would also like to begin my contribution with an acknowledgement that the overwhelming majority of practitioners are well-meaning and deeply respect our healthcare system and they continue to act to provide the best possible care for their patients.

This bill was referred to the community affairs committee for inquiry in the previous parliament. The nine submissions to the inquiry mostly included support for the changes within this bill, but there were some concerns and suggestions raised that I would like to raise in my time today. A young person made a submission to the inquiry, and, in her submission, she noted the importance of addressing fraud but emphasised:

…it is important to ensure that these powers do not create additional barriers for legitimate providers, which could inadvertently reduce the availability of services.

Further she added:

Simplifying processes is beneficial, however, it must not compromise the quality and safety standards that protect public health.

The Australian Greens agree with this sentiment and call on the government to ensure that Medicare continues to be grounded in the experiences and the processes required to ensure health care for consumers.

Another topic raised at the inquiry was the need to properly educate practitioners about the changes made by this bill. The Royal Australian College of General Practitioners said in their submission:

Compliance processes can be stressful for providers and affect the quality and timeliness of patient care. We maintain educational activities should be prioritised before compliance actions. Where reasonable, health professionals must be given an opportunity to adapt or rectify their billing practices prior to being subject to compliance activities.

As presented in the Philip review, a significant part of leakage in the Medicare payment system is due to simple mistakes from practitioners rather than premeditated fraud. As such, it is crucially important that there be more focus placed on educating and enabling practitioners to comply with changes rather than relying on punitive enforcement.

I would like to note that the Australian Medical Association also made a submission to the inquiry. They wrote:

The proposed amendments aim to broaden and update investigative powers to ensure consistent and effective use across health benefits schemes and include additional offences under the Criminal Code such as money laundering, forgery, and identity fraud.

…   …   …

The AMA acknowledges the Bill intends to balance additional powers with appropriate safeguards, including restrictions on when warrants may be issued and guidelines regarding officer conduct.

In their submission, it is clear that the AMA is supportive of the need for further evaluation to ensure the balance between sufficient investigatory powers and safeguards, and to ensure appropriate protections for individual providers. Other individuals who submitted to the inquiry also believed that more needs to be done to ensure the underlying problems within that system are addressed.

With these perspectives noted, the Australian Greens will be supporting this bill. It is our expectation that the government will continue to work with representative organisations and individual providers to ensure that sufficient safeguards are in place. More needs to be done, for example, to ensure that practitioners receive education regarding the expectations on them and the consequences if they fail to meet those expectations. Above all, the quality of health care for consumers must remain at the forefront and centre of all Medicare changes.

Today I am also really proud to be moving a second reading amendment to this bill on behalf of the Australian Greens. In this country we have a quiet crisis, where so many people cannot afford to access dental care. Now, many in this place and in the community know that the Greens are calling for the mouth to be considered as part of the body, with regard to getting dental care into Medicare. The Greens took a policy to the last election to put dental care into Medicare so that everyone with a Medicare card can access the dental care they need without breaking the bank. The reality is that too many people cannot access a dentist, because going to a dentist is far too expensive and most people are not eligible for public dentistry. For those that cannot access public dental services, the wait time can be years—years of living with preventable tooth decay, headaches and, in many cases, not being able to eat the food which they once enjoyed.

My amendment today calls on the government to fully fund and implement a seniors dental benefits scheme. The establishment of a seniors dental benefits scheme would go some of the way to supporting our community to get access to affordable dental care. The idea of a seniors dental benefits scheme is not new. The community and the sector have been calling for this for years. Notably, the Royal Commission into Aged Care Quality and Safety, back in 2021, recommended this very scheme, and the Senate Select Committee into the Provision of and Access to Dental Services in Australia recommended this in 2023. Years on, we still have had no action. Years of people living with preventable dental pain, yet this government continues to leave older Australians out in the cold when it comes to their oral health.

There are many, many stories of the consequences of successive governments failing to establish a seniors dental benefits scheme. I would like to share with you the story of Don Batty, who was featured by the ABC in an article published recently. Mr Batty is 80 years old. He is receiving the pension and he is experiencing severe dental issues. The way he describes it, in his words:

My teeth have started to disintegrate … I'm very embarrassed by my teeth and I try not to smile because I frighten people.

Don has been living with this for two years because he can't afford to see a private dentist and the public system is swamped. Don's story is one that I'm sure will resonate with senior Australians all over the country who are struggling to afford dental treatment—treatment they desperately need. The consequences? People are losing their social connection; it's impacting their mental health and, in many instances, people are struggling to eat the foods they once enjoyed. Mr Batty's experience is adding to the chorus for change. It's stories like his that are why the Australian Greens are calling on the government to establish a seniors dental benefit scheme as a step towards bringing dental care into Medicare for everyone.

Older Australians shouldn't be spending their retirement dealing with dental pain or missing teeth or the negative health effects that accompany untreated dental problems, and yet here we are. On average, Australians over 65 have lost 14 teeth. Twenty-five per cent avoid certain foods due to dental issues. The reality is that across Australia people are experiencing the cost-of-living crisis and 55 per cent of Australians over 65 delayed dental treatment in the last year, with affordability being the main barrier.

The Australian Dental Association supports the establishment of a seniors dental benefits scheme. The ADA, in collaboration with Primary Dental at Maroubra Medical and Dental Centre in Sydney and the University of Sydney, conducted a pilot program of a seniors dental benefits scheme, which included individualised dental plans as part of a GP provided healthcare program. The results of the pilot showed an improvement—an improvement!—in health outcomes, particularly in the management of tooth decay and gum disease. A participant in the pilot said:

Public dental waiting lists are too long, and I haven't seen a dentist for 5 years due to cost, and it was painful to eat and drink. Since I was on the pilot project, I have my new denture and I can eat a lot more food and drink than before.

The data is in. The pilot clearly demonstrated the value in providing affordable dental care to older Australians. We should make sure that people in their retirement, on the pension, struggling, can live free of dental pain. We should make sure that they can eat the food and drink the drinks that they once enjoyed, that they can smile without fear and that they can smile again with pride.

The next step must be for the government to commit to implementing the seniors dental benefits scheme. I call on everyone in this place to support our Greens amendment, to support, in principle, the establishment of a seniors dental benefits scheme. And while this amendment today will not establish a seniors dental benefits scheme, it sends a clear message to the Australian community, especially our older Australians, that we are going to get this done in this term of government. Otherwise, it is clear that the only party here who are committed to considering the mouth as part of the body and getting dental into Medicare is the Greens, and I foreshadow the Greens second reading amendment as listed on sheet No. 3360. Let us work together to bring dental care into medical care. Let us begin by helping our seniors who are living in dental pain, who are losing their social connection, their mobility and their health due to this unacceptable gap in our health system. It will take work together, it will take time and consultation and collaboration, but let us now begin. I move:

At the end of the motion, add ", but the Senate:

(a) notes that:

(i) the Royal Commission into Aged Care Quality and Safety recommended the establishment of a Senior Dental Benefits Scheme,

(ii) the Select Committee into the Provision of and Access to Dental Services in Australia recommended that the Government consider the establishment of a Senior Dental Benefits Scheme,

(iii) Australians are experiencing a cost of living crisis, and 55% of Australians over 65 delayed dental treatment in the last year with affordability being the main barrier; and

(b) calls on the Government to fully fund and implement a Senior Dental Benefits Scheme".