The $28 billion Medicare system is being abused by medical professionals who are rorting processes, and the fraud, errors and over-servicing is costing an estimated $8 billion a year.
A joint investigation by ABC's 7.30 program, The Sydney Morning Herald, and The Age has uncovered flaws that make the systems easy to rort and difficult to detect fraud and errors.
But how does it work and could it be happening to you?
How do they do it?
Some medical professionals billed for services they didn't do, such as billing dead people and falsifying patient records to increase their incomes.
When a health practitioner bulk bills for a service they send your bill directly to Medicare, making it free for you.
But if a doctor illegally bulk bills for a service you didn't get, they will be receiving money from Medicare that they aren't supposed to.
Documents obtained by the Herald, The Age and 7.30 as part of the investigation show an online telehealth company appears to have illegally bulk-billed patients while also charging $38 or $50 a visit.
Do the patients know?
Patients are often none the wiser when a claim is made by a health practitioner using their name, date of birth and Medicare number.
According to the investigation, inappropriate billing happens during the Medicare claims process, which patients usually aren't involved in.
And it's happening in all areas of the health sector, including GPs, surgeons, pathologists, anaesthetists, radiologists and dentists who use the child dental benefit scheme.
Many of the claims are less than $100, but that's what makes it easy for fraud to fly under the radar.
Could my GP be doing it and am I liable?
It's possible a health professional could be doing this to you.
You can check your Medicare claims history online through MyGov. It will show you the latest claims you've made through Medicare.
Here's how to do it:
- 1.Sign into your myGov account
- 2.If you've already linked your Medicare account to myGov, then click on 'Medicare' under linked services, if you haven't follow these steps
- 3.Once you're in your Medicare account, you will see quick links at the top with 'view claims history' written underneath
- 4.Click on 'view claims history' to see your latest claims.
According to Services Australia, health professionals are legally responsible for services billed under their provider number or in their name.
This includes any incorrect billing of services that result in overpayment of Medicare benefits, regardless of who does their billing or receives the benefit.
Penalties may apply to health professionals for incorrectly claimed services.
If you suspect there has been a false claim made, you should report it to the Department of Health and Aged Care.
Is this an industry-wide issue?
The investigation reports nearly 30 per cent of Medicare's annual budget is lost to leakage
But according to AMA President Professor Steve Robson, the "vast majority" of doctors do the right thing.
What's being done about it?
Federal Treasurer Jim Chalmers has described the investigation's findings as "troubling," and has declared the government will seek to get to the bottom of it.
"Very concerning reports, very troubling revelations," Dr Chalmers said.
"And something that we will get to the bottom of, because we don't want to see a single dollar rorted or thieved from the system when it could go to helping people who are vulnerable."
Health Minister Mark Butler has commissioned a report on the Health Department’s existing compliance and audit programs.
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