This appeared last week:
Call for cheating doctors to be named and shamed
By Melissa Cunningham and Henrietta Cook
November 17, 2024 — 5.00am
Doctors who overbill patients should be named and shamed on a public register, according to one of Australia’s top health economists, and a class action against a group of Mornington Peninsula doctors allegedly overcharging might be on the cards.
Patients have also been urged to check their Medicare records to ensure they have not been wrongly charged by their doctors.
The calls come after this masthead revealed allegations against dozens of anaesthetists and surgeons on Victoria’s Mornington Peninsula, in a damning confidential whistleblower complaint accusing them of systematic fraud, double-dipping and pocketing off-the-book fees.
The complaint alleges that a group of doctors has been charging patients hidden out-of-pocket costs up to $5000 – disguised as booking or administrative fees – for their own financial gain, while at the same time, the specialists were purporting to participate in no-gap-fee schemes with health insurers.
Medical fraud and compliance expert Dr Margaret Faux, who has previously worked as a solicitor, believes there may be scope for a class action lawsuit to help consumers if the allegations are proven.
“We actually need to get this in front of a judge as soon as possible,” she said. “This whistleblower letter is a gift in so far as it gives prosecutors everything they need to quickly and easily get to the truth of the matter.”
Faux said of concern were allegations that doctors have been charging fees for no service, which is illegal.
She said charging an anaesthetic administrative fee of more than $1000, with no explanation for example, could be deemed “suspicious”, because the law required consumers to be billed using Medicare codes.
“We know the names of all the doctors,” Faux said. “We know exactly where this alleged conduct is taking place, and there are no excuses for inaction.”
Health economist Stephen Duckett – the man widely regarded as the architect of Medicare – said that while the overwhelming majority of doctors strived to do the right thing, there was also evidence of a minority of greedy specialists who sought to game the system.
‘The patient gets screwed, the insurance fund gets screwed, and the doctor goes all the way to the bank.’
Duckett said doctors found to be breaching their contracts with insurers and overbilling patients “should be named and shamed” on a public register to warn consumers.
“Because the system is so complex, patients don’t know what their entitlements are, and they don’t know when they’re being ripped off,” Duckett said.
“Similarly, because the health fund doesn’t know that a booking fee was charged, they can’t police it on behalf of the patient. So, the patient gets screwed, the insurance fund gets screwed, and the doctor goes all the way to the bank.”
He said insurance funds also must tighten contracts with health practitioners to protect consumers and hold doctors to account.
“Insurers must be prepared to name doctors who are chiselling patients,” he said.
According to the whistleblower, during her employment at a Mornington Peninsula medical clinic which spanned a decade, about 90 per cent of patients were stung with out-of-pocket costs, despite the no-gap-fee arrangements.
Rachel David, the chief executive of Private Healthcare Australia, which represents insurers, has called for Australia to follow the United States and enact a “surprise billing legislation”, which mean if a patient is charged with a bill they don’t expect, they do not have to pay it. She cited instances where a specialist has added an assistant without telling a patient in advance.
“Raising a charge while a patient is under duress is unacceptable … if a patient challenged that under consumer laws I think they probably win.”
David has urged people to examine their medical bills for any service not attached to a Medicare item or for statements on bills labelled as “booking” or “administrative” fees.
“If it says that it’s a separate fee that Medicare or the health insurance fund won’t pay, that is a red flag,” David said.
Insurers nationwide are now scrambling to probe the claims of overbilling.
The federal government’s Benefits Integrity Division – which investigates claims of health and Medicare fraud – is also investigating.
Australian Patients Association chief executive Lisa Robins said hidden specialist billing eroded confidence in the system and deterred some people from taking up private health insurance.
“Many Australians have taken out private health insurance to avoid out-of-pocket expenses. These fees are a betrayal of patient trust and it’s incredibly disappointing to see allegations that some specialists are financially exploiting individuals when they are at their most vulnerable.”
She called on health ministers to put an end to unethical billing practices, which she said were putting undue financial pressure on patients during a cost-of-living crisis. She said healthcare providers also needed to be transparent about their billing.
A spokesman for the federal Department of Health and Aged Care said the government was unable to share details of its compliance investigations, including probes which are still under way.
How to check if you’ve been billed incorrectly under no-gap-fee arrangements
If you have private health insurance, call your health fund to examine your bills and ask questions about whether you should be paying out-of-pocket fees or not. They can help you ask the right questions of your provider. If your Medicare records show you were bulk-billed when you were charged a fee, report it to Medicare.
The Australian Society of Anaesthetists and the Royal Australasian College of Surgeons both said they take allegations of financial misconduct seriously, but strongly rejected suggestions unethical practices were commonplace or widespread.
Australians who have had surgery in private hospitals are being urged to scour their medical invoices and specialist doctors’ bills for “red flags” showing they have been charged hidden fees outside their health funds or Medicare.
How to report potential fraud to Medicare:
- Complete the Government’s health provider fraud tip-off form
- Call the national fraud hotline – 1800 829 403 or the Benefits Integrity Hotline1800 314 808
- Email ReportFraudorCorruption@health.gov.au
Here is the link:
I have to say this is really pretty sad – especially given the amounts one can make without resorting to such activity.
I wonder is the incidence rising compared with other professions?
David.
Faux is her name - Faux!
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