Independent review into Medicare compliance, integrity

Monday, 07 November, 2022

Independent review into Medicare compliance, integrity

The Albanese government has appointed health economist Dr Pradeep Philip to conduct an independent review into the integrity of Medicare and its compliance mechanisms.

As the Lead Partner at Deloitte Access Economics and a former Secretary of the Department of Health and Human Services in Victoria, Philip has a long history working at the highest levels of public policy in Australia.

A 2020 Australian National Audit Office (ANAO) report estimated the value of Medicare non-compliance at between $366 million and $2.2 billion a year.

The independent Philip Review will assess the possible value of fraudulent, non-compliant or overservicing risks in Medicare and provide a methodology and evidence-based estimate of the likely value of non-compliance in Medicare.

More than 500 million Medicare services are delivered each year totalling around $32 billion in government spending.

Philip will provide an interim report to the government by 31 January 2023, with the final report to be submitted by 28 February 2023.

Minister Mark Butler said, “Australians know that the overwhelming bulk of Australia’s doctors and health professionals are honest, hardworking and comply with Medicare rules. But they also understand that, after nine years of cuts and neglect, every dollar in Medicare is precious and must be spent directly on patient care.

“My department has provided a report on the existing compliance efforts, along with a rundown of the various estimates on the scale of the problem from the ANAO and others.

“The report found no evidence of the $8 billion in Medicare fraud and inappropriate billing estimated by Dr Faux.

“I’ve asked Dr Philip to measure and report on the true extent of non-compliance in Medicare and identify fixes to protect the integrity of the system, for all who use it.

“All governments must apply strict compliance standards to any publicly funded system — including Medicare — to ensure that the small minority that do the wrong thing are picked up quickly and dealt with.”

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