Let’s Talk About the Medicare “Fraud”

Two days ago the ABC published a scathing assessment of fraud and waste. Sadly, this alleged behaviour has generally been attributed to general practitioners (GPs).

My writing focuses on Movement As Medicine and the challenges of chronic illness. Doctors are a vital part of the life of any person with a chronic illness. At one point in my journey I had ten, yes, that’s right, TEN specialists. I am quite an experienced patient, one would suggest, including experience with the topic of billing. Furthermore, I am an accountant. And I have worked in hospital finance departments with exposure to the complexities of billing.

As a patient, I have skin in this game. You come after my doctors, you are coming after me too.

I will say upfront yes, I have no doubt fraud does occur. Let’s be honest here, I am an accountant yet I know full well there have been convictions of crooked accountants. There have been convictions of crooked lawyers. No profession is free of bad apples.

It is also very obvious that Medicare is a VERY complicated system. Sometimes even a stupid system. Example: I can not have two foot MRIs on the same day. Why? I have two feet. Should I have one MRI at 11:50 PM and the other at 12:10 AM the next day? This is a stupid rule. I know of a mother whose child was injured in a sporting accident. Child needed MRIs of BOTH lower limbs. Medicare rebate only allowable for one, so mother had to pay for the other MRI in full. I once went to a pathology collection site with three pathology request forms from three different doctors. I was told I’d need to come back the next day for one of them as two doctors had ordered the same test (amongst others). The pathology organisation in question would not automatically share the result of a single test. Protecting their revenue stream, yes, I get that. Not good, but not exactly illegal. I paid, in that case, as I did not have the time to visit again the next day.

Which brings me to the next point. Medicare is not just GPs. It covers pathology, imaging (MRIs, CTs, x-rays), child dental, psychology, specialists, surgeons, various allied health providers under Health Care Plans….. the list goes on. Why is it being suggested GPs are the primary alleged perpetrators here?

Medicare expert Dr Margaret Faux believes wrongful claims are being applied to millions of billings


Believes? Believes? I do hope Margaret doesn’t say to patients “I believe you have cancer, here take this chemo”. Actually, patients are safe, as Margaret is a lawyer, not a medical doctor. She has a PhD in “Claiming and compliance under the Medicare Benefits Schedule”, completed in October 2021. Interestingly she runs a medical billing business – more accurately an administrative solutions to the health care sector business that includes billing.

I’ll let you think about that, it would be inappropriate of me to comment further.

Quite rightly, many GPs are not feeling great about this sort of media coverage.

I don’t blame them. I’m upset on their behalf. I’m also, personally, concerned that this is being driven by the never-ending attempts by certain political persuasions to completely privatise our health system. To become the USA, where patients ration their insulin. Where you can’t choose your doctor, essentially your insurance company does. Where insurance companies can overrule medically indicated treatments.

I have no doubt errors occur. Classic example is the processing of bulk-billing then charging a gap fee. Simply administratively wrong as the patient then fails to met the safety net threshold (the gap must be recorded). This is lack of training, billing incorrectly does NOT advantage the doctor financially, it is simply incorrect. Not only do doctors need an MBBS or MD degree – they need a masters degree (or their staff do) in Complex Bureaucratic Nightmare Systems. Simplification would solve many of the issues.

Patients, including me, have come out in support of GPs.

I think Ronni Salt summed it up.

When the accusers can show me clear, forensic evidence of widespread fraud, then I will listen. I am not interested in rumour, innuendo and “believing”.

To my own GPs, my specialists, my surgeons and my allied health providers – THANK YOU from the bottom of my heart for your care of me.

Addendum: Since I wrote this article, the MJA’s (Medical Journal of Australia) Insight has published “Medicare rorts? We read Dr Faux’s thesis so you don’t have to“. A very good read!

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Robyn Dunphy

I offer exercise guidance to those with chronic medical conditions where exercise is beneficial.

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