HMRs under scrutiny

Simone Roberts

Launching the program, Human Services Minister Chris Ellison said all Australians need confidence that government programs are not being exploited.

HMRs, along with allied health services, dental health services and urgent after-hours care, were identified as open to abuse.

“Last year the National Compliance Program enabled Medicare Australia to achieve program savings of $250 million, through changes to the claiming and prescribing behaviour of providers,” the Minister said.

“In 2007-08, Medicare Australia will pay benefits of almost $30 billion to the public and health care providers on behalf of the Australian Government. Medicare therefore has a responsibility to taxpayers to ensure the correct health benefits are paid — no more and no less,” Senator Ellison said.

Medicare said new technology such as PBS Online had expanded opportunities for incorrect claiming by pharmacists, including fraud.

“We are particularly concerned that some people may exploit opportunities to claim for Medicare services or PBS medicine that have not been provided,” a Medicare statement said.

“We will increase online, real-time scrutiny of electronic claiming and work with law enforcement agencies and other specialist groups to develop responses when we identify transactions of concern.”

Other fraudulent practices Medicare has observed include pharmacists supplying a PBS medicine where the medical practitioner has specifically prescribed a non-PBS prescription; pharmacists supplying PBS medicine without a valid prescription; pharmacists supplying PBS medicine earlier than required or in greater quantities than necessary; and pharmacists directing and claiming the same prescriptions through different pharmacies.

As part of the 12-month program, Medicare will educate almost 4000 new health care providers, including 1900 pharmacy students, on how to correctly use Medicare and the PBS.