31 July 2009
VICTORIAN State Ombudsman George Brouwer has tabled a report in
Parliament alleging the Transport Accident Commission and WorkSafe
have been defrauded by up to 27 surgeons.
According to the report, the Ombudsman’s investigation has highlighted “
significant flaws in both organisations’ capacity to detect inappropriate medical
practitioner billing practices”.
The investigated started on 11 March 2008, and looked at the administrative
processes related to the management of payments made to 27 medical
practitioners and others for treating trauma patients.
In particular, the Ombudsman investigated Bayside Health, and concluded
that the organisations had failed to monitor and audit a surgeon’s bills. This
resulted in significant financial incentives for allegedly inappropriate billing practices.
The Bayside Health Report found a surgeon had billed the TAC, Victorian
WorkCover Authority and Medicare Australia for surgeries that were not
performed, surgeries he had not performed, utilising multiple item numbers
that are mutually exclusive and for surgery that was not necessary.
Ombudsman Brouwer says WorkSafe Victoria and the Transport Accident
Commission were initially sceptical about the concerns, but as the investigation
continued, both organisations have committed to deal with the issues raised.
The organisations have agreed to keep Brouwer updated on new payment
systems to minimise fraud, continue audits into payments to medical practitioners,
and develop policies to prosecute and recover cash from doctors.
No comments:
Post a Comment