Trash the integrity of all doctors on the basis of a few anecdotes? Makes a great headline.
Eight billion dollars leaking from Medicare each year!
You’ve got to be joking. Eight billion?!
I saw the headlines on the newspapers lying in driveways as I was walking my dog. To be honest my first thought was they’d discovered some glitch in the system. To the best of my knowledge there was no ongoing inquiry into Medicare, no major audit, no uptick in medicolegal fraud cases, no royal commission.
And of course there wasn’t.
While the headlines screamed phenomenal Medicare abuse by doctors, the great exposé relied on one PhD thesis.
According to the Nine newspapers report, Dr Margaret Faux* had “uncovered flaws in Medicare systems that make it easy to rort and impossible to detect fraud, incorrect payments and errors”.
That’s a long way from the headline that states definitively Medicare is losing $8bn a year to fraud, error and over-servicing. This is a beat-up of astronomical proportions.
Where is the evidence? Where is any detailed analysis of claims data? Exactly what proof is there that this is happening to anywhere near the extent estimated? There’s a world of difference between could and is.
Of course they don’t need that for a headline – all you need is a couple of good anecdotes. You need a doctor billing dead people – as highlighted on the ABC’s 7.30. How many doctors did you find billing dead people, Dr Faux? A dentist unnecessarily X-raying children for money. Exactly how many dentists did you find doing this “unconscionable” act, Dr Faux?
But in her words such rorts – overservicing and making false claims – aren’t just common, or even very common – they are “very, very common”. Seriously?
If it’s so bloody common what has the Professional Services Review Board been doing? They are the ones actually checking our claims. Did the journalists ask the current PSR chiefs what the state of the medical nation currently is? How many doctors are currently under review?
According to AMA president Professor Steve Robson, who actually contacted the Director of the PSR, approximately 0.1% of the medical profession are thought to rort the system. But that doesn’t make for good television, does it?
Instead 7.30 wheeled out an ex-head of the PSR from a decade ago, Dr Tony Webber. Ah – I remember Tony Webber. When Dr Webber was in charge, the PSR would annually publish a little booklet that documented, in minute detail, the transgressions of all the doctors that were ultimately prosecuted by the PSR in the previous year for various types of Medicare fraud.
Every year you could guarantee these vignettes would get top billing in all the media, with Dr Webber offering his perspective on how bad doctors were and why they continued to fail. Even now, a decade later, it makes my blood boil because the reality was, the number of these wicked doctors barely reached double digits. Out of about 70,000 doctors nationwide. The mileage he and his organisation got from this tiny cohort of medical unprofessionals was staggering.
Just as is happening now, the blackening of the name of the entire profession was the consequence of the expose of a handful of “bad eggs”. It is simply outrageous.
And yes, I know – the journalists and Dr Faux did mention that genuine errors could contribute to the estimated $8bn Medicare wastage. However, no airplay or newspaper real estate was devoted to that possibility. The whole focus was on rorting, milking, gaming and out-and-out fraud.
The Dr Faux statement that really nearly tipped me over the edge was: “the bottom line is we don’t know exactly how much is fraud, deliberate abuse and how much is errors, but it actually doesn’t matter any more. Whether it’s deliberate or unintentional, it has to stop.”
I’m sorry, Dr Faux. It does matter. It matters a whole lot.
“Error” is a system failure, a likely consequence of a complicated, ambiguous coding program.
“Fraud” cuts to the integrity of the profession and to my mind such a broad-brush accusation is what is unconscionable.
The 7.30 piece presented not one single voice in defence of doctors. Not one. No college head, no medicolegal representative, no current PSR spokesperson, no AMA member – not a one.
How did such a piece get legs? How did it get top billing on television? Front-page headlines? Airplay on every radio station? Health minister buy-in?
I have no idea.
It may be just me, but I feel doctors have been feeling the love of late. The covid pandemic and our role in the battle against it seemed to have upped our approval rating and we have been enjoying greater trust and appreciation than we have had for a while. People, including politicians, seemed to be hearing our pleas for help to mend our crumbling primary health care system.
And now this.
Just as we stick our heads above the parapet, here come the slings and arrows of outrageous fraud claims. What will the public hear? “There’s plenty of money in the system if you just stop rorting it”. You’ve got to wonder at the timing and the intensity of this story.
What do we do now? God knows.
Mud sticks. Even if the “investigative” journalists did another piece on how much it would cost Medicare if doctors stopped under-billing and actually charged for everything they did – it would never get traction. It is so frustratingly unjust.
Greater brains than mine are no doubt working on a damage-control and counter-attack strategy – or at least I hope so.
Until then I’ll go back to my practice, where every consult is timed, documented and accounted for, every pathology and imaging request can be justified, and every care plan is done, first and foremost to benefit the patient to access podiatry or psychology – just as it is in the overwhelming majority of practices all around the country.
And I hope that this thesis and the reports on it die a million deaths, and we find a way to show this story to be the biased, lazy, dangerous piece of sensationalist crap it really is.
*Dr Margaret Faux has been a regular contributor to The Medical Republic on the topics of Medicare complexity and PSR overreach. Dr Faux will write again next week to defend herself from the criticism she has received for her part in this week’s reporting, and by mutual agreement that will be Dr Faux’s last column for TMR for the foreseeable future.
