NCJ Number
86647
Date Published
1981
Length
69 pages
Annotation
This series of seminar papers examines aspects of medical fraud and overservicing occurring under Australia's Health Insurance Act, including techniques of fraud investigation and privacy protection in investigations.
Abstract
Australia's Health Insurance Act, commonly known as 'Medibank,' introduced a system of funding medical services which is an invitation to overuse and fraud by both the community and the medical profession. Abuses of the act include the submitting of false statements about medical services provided for payment, the provision of medical services not needed by the patient, and the itemizing of every possible service that may have been provided in the treatment of a patient. Some in the medical profession view the administration of the Health Insurance Act as an excuse to enrich the power and wealth of the bureaucrats involved. It is argued that abuses in the administration of the program are perhaps more serious than any abuses by physicians. Medical fraud and overservicing are defined in the act, and as an aid in investigation, a computerized statistical summary can be provided on the services and benefits associated with each doctor during a given quarter. Medical committees of five medical practitioners examine allegations of overservicing. Some view the medical profession as being highly protective of its members, even to the extent of overlooking criminal activity, such that more clearly defined legislation and mechanisms of enforcement are required from the government, even though it may mean encroachments upon clinical freedom. Seminar discussions on each paper are provided. For individual entries, see NCJ 86648-49.