Australian Government to Investigate Claims about Multi-Billion Dollar Medicare Fraud

Medicare cards are seen in Melbourne, Australia, on July 10, 2017. Michael Dodge/Getty Images

Australian Health Minister Mark Butler has committed to investigating claims that billions of dollars are lost each year due to fraud in the Medicare system.

This comes following a joint report by the Australian Broadcasting Corporation (ABC) and Nine newspapers, which alleged that some practitioners were swindling Medicare and charging for non-delivered services.

The news outlets cited a Medicare expert who estimated that up to $8 billion (US$4.98 billion) could be lost to fraud and dishonest practices each year.

The report listed many examples of such malpractices, including billing dead people, falsifying patient medical records and overcharging underserviced patients.

The minister said he asked the Department of Health to conduct a report on compliance, audit measures and review programs, as well as perform an analysis based on the work of experts who had examined Medicare claiming and compliance.

“All governments must apply strict compliance standards to any publicly funded system–including Medicare–to ensure that the small minority that does the wrong thing are picked up quickly and dealt with,” Butler said in a statement.

“Australians know that the overwhelming bulk of Australia’s doctors and health professionals are honest, hardworking and comply with Medicare rules.”

A nurse performs a consultation with a patient at a COVID-19 and flu assessment clinic in Sydney, Australia, on May 12, 2020. Lisa Maree Williams/Getty Images

Treasurer Jim Chalmers described the alleged Medicare fraud as atrocious and said it needed to be examined.

“If these numbers are true, it’s absolutely atrocious. Every dollar rorted, whether it’s from Medicare or the NDIS, is a dollar thieved from people who need and deserve good health care,” he told reporters in Canberra.

“If you’re stealing from Medicare or the NDIS, you’re a grub. It means that money that’s not exactly thick on the ground in the budget is not going to people who need it.”

Response from the Medical Profession

Meanwhile, the country’s peak medical body criticised the report, calling it a slur on the profession.

Australian Medical Association (AMA) president Steve Robson said that most doctors did the right thing for their patients and worked hard under tremendous pressure within the system.

“Doctors will be sickened by today’s reporting, which is an undeserved attack on the whole profession based very much on anecdotes and individual cases,” he said.

“The AMA works closely with the Department of Health on compliance, and we have never seen any concerns or numbers that would support the figures reported today.”

Robson then said his organisation did not tolerate fraud and that the figures mentioned in the news report were “grossly inflated.”

While Government Services Minister Bill Shorten acknowledged that most general practitioners did not engage in fraudulent practices, he said there was a problem with payment integrity.

“It drives taxpayers to despair if they think that some people are opportunistically rorting the system,” he told Nine’s Today.

“Crooks do leave footprints ... Obviously, we have got to make sure there is complete confidence in the system, but we need to put the crooks on notice that you will get caught.”