Cheating Doctors Targeted By Crackdown
The Age
Thursday April 12, 2007
FRAUDSTER doctors, psychologists and other health workers are facing a crackdown by private health insurers who have banded together to share information about dodgy practitioners in a bid to stop them practising and keep a lid on member premiums.
Health fund members who try to rort insurers may have details of their scams shared between funds. Previously, insurers have been prevented from warning each other about fraudulent health providers and members by threats that they could be accused of anti-competitive conduct or collusion. The funds have now received advice from Australia's competition watchdog that they can share information about suspected fraudsters without being sanctioned for collusion, according to the Australian Health Insurance Association.The association has drafted a code of conduct to govern information-sharing between the funds when they suspect "unlawful, inappropriate or wrongful activity" by health fund providers, members or staff. The Australian Competition and Consumer Commission has told the association that if health funds follow the code when sharing information, the ACCC would be unlikely to find they had engaged in anti-competitive conduct, according to association chief executive Michael Armitage. The move comes in the wake of Queensland's Dr Death scandal and amid increasing fears that unqualified and unscrupulous health providers are costing the Australian health system millions of dollars and, in some cases, putting patients at risk. Dr Armitage estimates that fraud costs the industry 1-1.5 per cent of benefits paid out each year. This would equal around $87.5 million, based on the latest figures from the Private Health Insurance Administration Council, the Government's regulator. The association drew up the code of conduct and sought the ACCC's opinion on it after a doctor who had been caught providing unnecessary services to boost his profits threatened to take a health insurer to the ACCC if it alerted other insurers to his actions, Dr Armitage said.Other scams that have been pulled on health funds include: speech therapists charging insurers for teaching English as a second language; optometrists providing children with normal glasses but charging an insurer for multifocals; dentists claiming several procedures for a single tooth; and massage therapists claiming benefits that should be paid only to qualified physiotherapists, according to data compiled by AHIA's fraud and security committee.The association's code of conduct sets out what kind of information can be shared, such as the types of health care services provided or the amount charged and the reasons why unlawful activity is suspected. It also says that information can be "shared only insofar as is necessary to enable health funds to investigate whether suspected unlawful or inappropriate activity has occurred, is occurring or is likely to occur".Gayle Ginnane, CEO of the regulator, said health funds had, in the past, advised it about fraud. "Provided that it is not anti-competitive - and that's what the ACCC decides - sharing of information to prevent fraud would clearly help to lower the cost of health insurance and therefore would seem to me to be in the consumer interest."While Ms Ginnane would not say whether health funds should share with their members the names of dodgy health providers, "there certainly needs to be some way of protecting consumers from providers of any kind that either don't provide services that they charge for or provide services that are unnecessary".Consumers' Health Forum executive director Helen Hopkins said that while misleading claims should be appropriately investigated, "we also want to be sure that consumers and their doctors and health care providers retain their right to choose the most appropriate treatment".
© 2007 The Age
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