Radio interview with Minister Butler and Patricia Karvelas, RN Breakfast - 18 October 2022

Read the transcript of the radio interview with Minister Butler and Patricia Karvelas on Medicare fraud, aged care sector and the StewartBrown report, and reintroducing bulk billed psychiatric telehealth consultations for regional and rural Australia.

The Hon Mark Butler MP
Minister for Health and Aged Care

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PATRICIA KARVELAS, HOST: The Health Minister Mark Butler is our guest this morning. Minister, welcome.
 
MINISTER FOR HEALTH AND AGED CARE, MARK BUTLER: Morning, Patricia.
 
KARVELAS: Now the reports claim $8 billion is being misspent every year. Doctors claim the contrary, arguing doctors, in fact, under-claim on consultations. Whose side do you come down on?
 
BUTLER: I want to come down on the side of truth, obviously.
 
KARVELAS: Who's right?
 
BUTLER: I've asked the department for an analysis of Dr Faux’s PhD thesis, which is essentially the basis of the investigation that the ABC and the Channel Nine papers are doing.
 
I will say that the figure used by Dr Faux is substantially higher, I mean enormously higher, than any figure I think that's been employed to date, including a figure from the Audit Office, the Australian National Audit Office only a couple of years ago.
 
So, it does seem extraordinarily high. I understand the reaction from the AMA to the concept that 30% of consults are inappropriately billed. Because a figure like that has never been used in spite of the pretty long-standing compliance and audit systems that governments of both political persuasions have had.
 
But obviously your listeners would expect me to take these reports seriously, which is why I've asked the Department not only for an analysis of Dr Faux's work, but also a report to me, as still a relatively new Minister on the current audit, compliance and Professional Services Review programs.
 
KARVELAS: So, do you acknowledge there is fraud in the Medicare system? And what is your understanding of how widespread it is?
 
BUTLER: Well, there is fraud in the Medicare system, unfortunately. I mean, there are more than 500 million Medicare services delivered every year. And, you know, when you're talking about that sort of scale, there will inevitably be the odd bad apple.
 
There are 24 cases in front of the courts, for example, right now where prosecutions are being are being pursued for fraud. There are another dozen and a half cases that have been referred to the Commonwealth Director of Public Prosecutions.
 
So, there is, and there has always been, a small number of cases of fraud and they’re pursued appropriately. There's a strong compliance program that does advanced data analytics to try and pick this up.
 
KARVELAS: The words small number is what I pick up there, and I'm sure the listeners heard it too.
 
BUTLER: Well, there are many, many thousands of honest, hardworking health professionals who every day deliver hundreds and hundreds of thousands of Medicare services. That doesn't mean that there's not the odd bad apple, the 730 Report covered a couple of individual cases yesterday that had been picked up as well.
 
But I'm not going to do anything other than defend the extraordinary, honest, hard work that tens of thousands of health professionals deliver every single day in a program of which all Australians are proud - Medicare.
 
But in my experience, no one is prouder than those health professionals, particularly GP's and the nurses and allied health professionals that work in the teams that they lead.
 
KARVELAS: $8 billion is an extraordinarily high number. It represents more than a quarter of Medicare's annual budget. You're saying you don’t really believe that that figure is accurate?
 
BUTLER: Well, I mean, all I'm saying is that it's way out of whack with any other figure that's ever been provided to government, including, as I said, by the National Audit Office, that only did a review of the program a couple of years ago.
 
But I'm taking it seriously. I've asked the Department for some formal analysis of the work. I've also asked for a report on the compliance programs because, you know, we understand as much as anyone just how precious every single dollar going into Medicare is.
 
And we want to make sure that we do everything we can as a government to ensure that every dollar is spent wisely. Because, you know, after six years of a Medicare rebate freeze, as I think you said in your introduction, people are finding it really hard to get into a doctor.
 
And when they do get into a doctor, they're seeing bulk billing rates in retreat. They're paying higher gaps than they ever did. So, any single case of fraud or improper claiming is - particularly right now, given the state of crisis in general practice - going to raise very serious levels of concern in the Australian population, including the Australian medical community.
 
KARVELAS: So, tell me you've said you've asked your department to look at this, which is clearly the right thing to do, there needs to be an investigation into this, no doubt.
 
What's the timeframe? And will it lead to reform? Does the system need to be tightened?
 
BUTLER: Well, I'm not going to pre-empt what comes back to me and my own assessment of that. I mean, if there's any change to the Professional Services Review system that I think is warranted, we’ll pursue that.
 
I know there have been a range of complaints over the years from the medical community and from independent academics like Dr Faux about the system.
 
And I'm always open to ways in which we can ensure that taxpayers get the best value for money, but also that claimers, health professionals and doctors are treated fairly, given proper natural justice and the like as well.
 
So, as I said, I'm still a relatively new Health Minister. We've been out of government for nine years and it's a timely opportunity for us to have a thorough look at the way in which the audit and compliance system is working and ensuring that - particularly at a time where every single dollar going to Medicare is so precious - that we're getting the maximum value for that money.
 
KARVELAS: Minister, as we've heard, many doctors claim there are hundreds of appointments that they are undercharged for. There's even stories of doctors spending their own time and money to help our most vulnerable.
 
I know doctors in my own life who do that all the time at their own. You know, they basically lose their own money, but they absolutely make the judgement that they need to help people.
 
Have you looked at how the system is failing them?
 
BUTLER: Well, there’s no question, I think all of us understand that through our own experience and talking to doctors and other health professional groups, just how much health professionals go above and beyond and do take that call or do spend that extra time with a patient who is in need.
 
And that's one of the great things we love about our health care system. As I think I've talked to you before, Patricia, I'm sitting down with doctors and nursing and allied health professional groups, importantly also patient groups, right now to look at a range of changes we can make to strengthen Medicare.
 
We’ll be reporting by the end of the year and we've had a fantastic discussion. I'm chairing those meetings directly. We've had a fantastic discussion about ways in which we can modernise as well as strengthen Medicare, make sure that when you go to a general practice, you're getting wraparound care not just from your doctor, but from nurses and health professionals who can who can help as well, that we're really tapping into the opportunities of digital health and doing a range of other things that have really been talked about for many years but just haven't been delivered.
 
KARVELAS: Minister, you're also the Minister for Aged Care, accounting firm StewartBrown surveyed more than 1,300 aged care homes and it found two thirds operated at a loss last year. These facilities won't be able to continue to lose money. Are you worried the sector could be at risk of collapse?
 
BUTLER: Well, I've been reading the StewartBrown reports for many years, Patricia, and they're a really important part of the jigsaw puzzle as we understand what's happening in aged care. They're not the only thing, of course. Your listeners would expect me to make an independent assessment of this rather than just rely upon a report commissioned on behalf of aged care providers.

But we have been saying for some years, the Labor Party that is, that the aged care system is in crisis. There were there were a range of budget cuts put in place by Scott Morrison when he was Treasurer and then Prime Minister that really pushed the aged care sector to the brink.
 
We've been saying that, honest about that, for some time. The first piece of legislation that Anika Wells, the Aged Care Minister, was able to get through the parliament on behalf of the government, introduced a new funding system which came into effect only a couple of weeks ago, recommended by the Royal Commission, which on average - we're confident - will lift the level of funding per resident by about 10%.
 
We're confident that what we've put in place already is going to alleviate that pressure. We'll obviously have to see that operate for more than a couple of weeks. We've got a range of other reforms we're committed to introducing. There's already legislation in the parliament to make sure that every facility has a registered nurse on duty 24 hours a day, seven days a week, additional staff in 2024. So, this is an absolute priority of the Albanese Government.
 
The headline conclusions from this report are no surprise to a party that's been saying this for two or three years: that the aged care sector was pushed into crisis by the former government.
 
KARVELAS: Minister, if we can turn to mental health funding, you've announced you'll reinstate bulk billing for video telehealth psychiatric consultations in rural and regional areas. That's been welcomed by the sector, but bulk billing doesn't cover the cost of a consultation, leaving people with significant gap payments that could prevent them from seeking help.
 
How much difference will it actually make?
 
BUTLER: This will mean that every consult delivered under this program will be bulk billed. This was a program that was introduced when I was Mental Health Minister a decade ago, and it really closed that tyranny of distance, particularly for people in rural and regional Australia that don’t have a psychiatrist living in their town but desperately need the sort of support that a psychiatrist can give.
 
The difference between mental health and physical health ailments is that you can do a consultation over a good video link. And I know just how important that was over the last ten years to closing that gap – that physical gap, that geographical gap – for regional and rural Australia.
 
I was quite shocked when the Morrison Government cut that program in December with no notice, no particular advice behind it - at a time when rural and regional Australia were not only dealing with COVID, but just a wave of natural disasters and needed that mental health support.
 
We made the commitment to reintroduce it. The consults will be delivered on a bulk billed basis, and we think that more than 100,000 consults each year will be delivered under this program and will provide that level of mental health support that’s a lot easier sometimes to get in the major cities than it is for regional and rural Australia.
 
KARVELAS: Thank you so much for joining us this morning, Minister.
 
BUTLER: Thank you Patricia.

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