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House of Assembly - Fifty-Second Parliament, Second Session (52-2)
2012-04-03 Daily Xml
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MEDICARE BILLING

Mr HAMILTON-SMITH (Waite) (15:11): My question is again to the Minister for Health. Has the minister authorised a process whereby salaried doctors in the state health system have their Medicare provider numbers used to bill the commonwealth for services provided at state-run hospitals by reclassing patients as private rather than public patients? Is he absolutely certain that the arrangement is both legal and compliant with federal government regulatory requirements?

The Hon. J.D. HILL (Kaurna—Minister for Health and Ageing, Minister for Mental Health and Substance Abuse, Minister for the Arts) (15:12): I thank the member for his question. I think he is referring to a report that was in InDaily recently following an interview with me. I will just go through what was alleged and give the house the best information I can in relation to this.

The article in InDaily, and I guess it is the substance of the member's questions, makes three allegations: that doctor provider numbers are being used within the SA public hospital system without the doctors' knowledge, that the South Australian health policy directive around outpatient billing practices released in November 2011 is deliberately aimed at cost-shifting, and that South Australian public hospitals require doctors to sign over rights to bulk billing funds, which are pushed into a trust fund, claiming concerns about tax implications and whether this practice is legal under current health laws. I think they are the issues.

I am advised that SA Health does not condone any doctor's provider number being used without their knowledge, nor does it condone doctors billing Medicare when they have not seen the patient. These practices are not consistent with SA Health's directives or SA Health's understanding of the Medicare rules. The Department for Health and Ageing is currently undertaking a systematic implementation of its directive released in November 2011 across the major metropolitan hospitals, and these instances have not been identified to date. If there is any evidence of such practices occurring, I would certainly welcome advice of that and we will deal with it. Any allegations about possible noncompliance are taken very seriously.

The purpose of SA Health's directive is to communicate compliance requirements to doctors to ensure best practice arrangements and consistency across South Australian public hospitals. The quote in the article about patient choice to be a public or Medicare-billed patient is accurate and appropriate and reflects the National Health Reform Agreement requirement for patients to make informed patient election choices, which include informed financial consent. So, patients can choose.

I am advised that the allegation in the article that doctors are required to sign over their rights to bulk-billed funds is not true. Doctors receive Medicare Benefits Schedule payments based on their specific private practice arrangements up to the ceilings as defined in their specific enterprise agreements. There is no official 100 per cent give-back scheme, but there are some doctors who voluntarily choose to donate their full Medicare Benefits Schedule payments. These doctors are provided with financial reports on billing to assist them with submitting their tax return.

In all cases, the doctor has a right to Medicare billing income, noting that there are different administrative arrangements for this to occur. SA Health has obtained two rulings from the commonwealth Commissioner of Taxation that these arrangements are legal from a tax perspective. These rulings provide doctors with the required advice about their tax obligations. Crown law advice has been received in the preparation of the November 2011 directive and SA Health is satisfied that such arrangements are appropriate and within required legal obligations. The directive is critical to ensure that doctors fully understand their obligations when providing private practice in public hospitals.

This is a complex area that we are dealing with but (if I can summarise it in street language) what we are attempting to do is to make sure that we obtain every dollar that the commonwealth is prepared to pay into our system. We obviously want to do that within appropriate legal forms. New South Wales in particular is heavily involved in this kind of practice where a lot of the services are funded through Medicare, and I think other states are as well. We have not had the same level of benefit as some of the other states.

In relation to the question about whether or not we were cost-shifting I made the point that, 'Sure, the commonwealth over the last 10 or so years has cost-shifted enormously onto the states. The commonwealth used to pay 50 per cent of the cost of hospital care in our hospitals and they now pay around 40 per cent.' As I said to the journalist who interviewed me, 'If I can put some of that cost back onto the commonwealth I would be a mug not to do it.' That is certainly the view of this government and I am sure if the other side were in power they would look—and the shadow treasurer is not here—

Members interjecting:

The SPEAKER: Order!

The Hon. J.D. HILL: I am sure the shadow treasurer would look at this and say, 'This is perfectly legal and perfectly reasonable and there is a code of practice which has been developed and published and we're applying it.'

Members interjecting:

The SPEAKER: Order! Point of order.

Mr WILLIAMS: Point of order, Madam Speaker: I draw your attention to sessional orders which state that an answer should be limited to four minutes.

The SPEAKER: Thank you; I was going to point it out to the minister but he was coming to a conclusion. Member for Waite.

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