Fraud & corruption in Howard's health system

One of the challenges for Labor in ensuring we can all get to a doctor when we need one -- no matter where we live, no matter who we are -- will be dealing with those after hours medical practices where massive rip-offs of medicare take place.

These practices don't just de-fraud the Commonwealth, they provide no after hours services at all. Patients are left with nowhere to go but the emergency department of their nearest public hospital.

Medical practices who supply after-hours services receive a Practice Incentive Program payment (PIP). Labor will retain the payment, but reform the system under which it is paid, as currently, these payments are subject to substantial fraud.

Labor says that industry sources estimate fraud levels are as high as 45 per cent of all claims. One after hours practice was recently audited and fraud levels were found to be over 90 per cent of all claims! The Howard Government has well and truly taken its eye off the ball here.

The fraud can happen in a number of ways but a simple example is that of a general practitioner claiming to provide an after hours service, claiming the PIP payment, but actually providing no service at all.

This fraud could take the form of:

• Not advising patients of an after hours contact number

• Having an after hours number that is unanswered

• Having an after hours number referring patients to the emergency department of the nearest hospital.

A more outrageous example is in the GP who is both greedy and uncaring.

This doctor claims to provide an after hours service but charges at a rate that discourages or eliminates anyone from using it. Prices quoted range from $150 to $450 per home visit.

This is how this gigantic scam is happening:

A patients rings a GP for an after hours consultation. The call diverts to a commercial call centre and the patient is advised that call charges of $4 per minute apply. At this point of the call, 80 per cent of patients simply hang up.

For the desperate patient who does proceed with the call, an operator will then advise that there is a cost charged for contacting the GP which must be paid in advance by credit card. If you have one.

Typically, the cost of speaking directly to the doctor is $60. If you agree to all this your telephone number will be recorded and the GP will be contacted. The doctor speaks directly to the patient only after the credit card has been debited.

If the GP and the patient then agree to a home visit, then a further charge of anywhere between $150 and $450 is deducted from the credit card. All costs must be paid in advance.

Patients are told by the call centre operator that free medical help can be had at the emergency department of their local hospital.

A Latham Labor Government has these practices firmly in their sights and will make certain that GPs claiming to provide their own after hours service do just that. And it will have to be genuinely accessible - financially and geographically. Audits of PIP claims will be substantially strengthened.

Labor Government reforms will:

• Improve the availability of real after hours care in Australia

• Ensure the phantom services era is over and the Commonwealth pays only for actual after hours care services

• Redeploy the $5 -10 million saved to effective health care delivery

• Make sure Australians are made aware of the after hours services available to them. GPs receiving PIP after hours payments will be required to advise their patients what after hours arrangements are in place.