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    Jim

    It is most interesting to hear a defence of Medicare from somebody who has built a private business out of helping providers navigate it. It seems to me thatone would be opposed to a new, improved and more automated system when you turn a buck from the current mess. Nor would you want another private business coming near your patch.

    Apart from the evident self interest on display, It is also interesting to see cited as a benefit of the current approach the apparent effectiveness of DHS staff in differentiating between legitimate plastic surgery claims and illegitimate cosmetic surgery claims. There is plenty of evidence to the contrary, to the point the Department of Health is continually trying to tighten the definitions to stop dodgy providers from billing cosmetic services as medically necessary. When even the Australian Society of Plastic Surgeons acknowledges its member routinely do the wrong thing, safe in the knowledge they will never be caught, it is time to dial down the praise for the current approach.

    I certainly agree that taking the word of American vendors that they could waltz in to Australia, roll out an overseas model and have it be an effective solution for our unique Medicare needs needs to be viewed very skeptically. For the same reason i don’t quite buy the argument the missteps and failures of these vendors, in the American system, would be replayed here.

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    1. 1.1
      Jennifer Doggett

      Jennifer Doggett

      Margaret Faux has provided the following response:

      Thanks for giving me the opportunity to repeat that I have a conflict of interest which was noted on this article and was the subject of on air discussion with Phillip Adams a few months ago. In actual fact, I have a lot to gain by responding to any government tender or opportunity to outsource medical billing in Australia. My company is well positioned to assist in the privatisation of Medicare payments but I just can’t in good conscious do that – knowing what I do about the genius behind the structure of Medicare I could not feel okay about skimming off part of the Medicare payment as profit – currently I am paid in the same way as medical receptionists, secretaries and practice managers. However, it is unlikely that privatisation contractors will have strong regard for the central importance to everyday Australians of universal health cover and frankly, it is not in their interests to limit the ways they could profit from privatisation.

      In regards your second point about doctors (plastic surgeons) rorting the system, that goes directly to my PhD topic. As someone who spent months scouring the international academic literature looking for evidence of your assertion that doctors are all out there deliberately cheating Medicare, I must completely reject your claim as being false. In addition, international academic literature on the topic of healthcare fraud and inappropriate claiming all agrees on one thing – healthcare fraud is very difficult to prove and almost impossible to accurately quantify. You will help the worlds academics who are researching this area if you can share your source of empirical evidence with us.

      However if your intuition is right, then I am staggered at your suggestion that fraud is nothing more than a ‘misstep’ or ‘failure’ of a vendor. It is not a misstep or a failure it is a crime. And to suggest that it could not happen here is not only naïve, but baseless. In this country we already have problems with questionable handling of Medicare rebates, which are placed in the hands of private health funds, but it’s a phenomenon currently hidden from consumers like you and I. Allowing other vendors to expand on the practice would be very risky, particularly in the current operating environment where there is no transparency or visibility over the journey of Medicare dollars. But perhaps a system overhaul will regulate and make accountable those who are given the privilege of handling Medicare dollars as I alluded to in my article. I would also point out that in the USA, the Medicare Administrative Contractors who handle payments for the US Government do not actually handle the money, yet still there are problems. The reason is this: the cheapest way to process a medical claim is to pay it without question. Auditing is expensive, and so contractors don’t want to do it because it affects their bottom lines and where does that lead? Their profits go up, but so does the incidence of inappropriate claiming, which then pushes overall health spending up and so the cycle goes.

      Thank you for doing your part in interrogating my arguments, and expressing your views about Medicare, which is a topic I am passionate about. I want to finish by making one thing very clear – I do support an upgrade to Medicare’s computers and I said that in my article, but it needs to be handled with great care, and dismissing it out of hand as a scare campaign was in my view irresponsible, almost negligent journalism. Consumers need to understand the risks and be involved in a mature discussion on any changes to Medicare, because it affects us all.​

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