Even surrounded by scandals Labor supports this crackdown on Medicare FRAUD. After all this is saving the taxpayers money.
Medicare data matching laws waved through, Despite privacy concerns.
By Justin Hendry Dec 6 2019 1:00PM
The Department of Health will introduce a new Medicare data matching scheme to better detect fraudulent or incorrect claims after the underpinning legislation passed through parliament.
The Health Legislation Amendment (Data-Matching and Other Matters) Bill 2019 passed into law on the last sitting day of the year on Thursday, having cleared the senate without amendments.
The bill passed the lower house with Labor’s backing last week after ‘careful and close’ inspection, according to shadow health minister Chris Bowen.
“We examined [the bill] to ensure that it is as presented, and we are satisfied that it is worthy of support and passage through the parliament,” he said at the time.
The law – which was introduced in October, only two weeks after the consultation period closed – gives the department expanded powers to access and share health information for compliance purposes.
With the assistance of Services Australia, it is aimed at helping the department recover a greater percentage of the almost $2 billion in Medicare and other health services claims estimated to be either fraudulent or inadvertently non-compliant each year.
This includes unrestricted freedom to access sensitive Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data, which was previously accessible in only “narrow circumstances”.
At least some of this information could also be disclosed to other federal government agencies under the law for Medicare compliance purposes and to “assist them in performing their functions”.
The laws also allow private health Insurers to provide data to the department on a “voluntary basis” for Medicare compliance activities, though Medicare data will not be shared with those insurers.
On Thursday, Labor senator Carol Brown reiterated the party’s support for the laws, noting the department had ruled out introducing any automation and would not share information with private health insurers.
“Labor will support this bill ... to improve Medicare compliance by allowing data matching between agencies,” she said.
“The bill will help to identify and take action against the very small number of health providers that make inappropriate Medicare claims.
“Importantly, however, it will not allow the government to share information with private health insurers.
“I welcome the minister's assurance that compliance activities won’t be automated, which would be akin to the disastrous robodebt scheme.”
The support comes despite a number of serious privacy concerns with laws being raised during the consultation process, including by the Australian Medical Association (AMA).
The AMA said the bill “did not strike the right balance between using matched data for MBS/PBS compliance and the patient’s rights to privacy”.
It was also concerned with the provision that allows private health insurers to provide the department with information for compliance activity, which it said could result in a situation where insurers “send their entire database to the department in the hope [it] will identify and query outliers”.
Brown said close attention would be paid to the legislative instrument that the law requires health minister Greg Hunt to introduce.
The legislative instrument will outline the “principles in relation to the matching of information which will ensure appropriate governance”, according to the law’s explanatory memorandum [pdf].
“The bill requires the minister to make a legislative instrument to govern the new data matching program,” senator Brown said.
“Among others, the AMA has pointed out there is little detail in this bill and the devil will be in the detail of the legislative instrument.
“Labor shares that view and I can ensure the sector that we will be scrutinising the eventual instrument very closely.”
https://www.itnews.com.au/news/medicare ... ugh-535055
Medicare FRAUD crackdown
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Juliar
- Posts: 1355
- Joined: Wed Dec 28, 2016 10:56 am
Re: Medicare FRAUD crackdown
Now the real reason for the Govt crackdown on medicare - FRAUD!!!
Police Medicare details for sale on dark web Sites used to traffic personal data of high-profile feds.
By Casey Tonkin on Dec 17 2019 11:28 AM
Former AFP commissioners had their personal data sold on the dark web. Image: Shutterstock
Three former Australian Federal Police (AFP) commissioners had their Medicare details put up for sale on the dark web.
Documents released through freedom of information (FOI) reveal that former AFP commissioners Mick Keelty, Tony Negus, and Andrew Colvin had their Medicare details placed on the now-defunct Alphabay marketplace.
An AFP spokesperson told the ABC that it knew the commissioners’ details had been up for sale, but did not know if any were ever sold.
Journalist Paul Farrell lodged the FOI request.
He has been following the dark web sale of Medicare information since buying his own card details off the dark web in 2017.
Paul Farrell · Dec 17, 2019
The department of human services has responsibility for the Medicare system but it won’t comment on what happened
Two years ago I bought my own Medicare card details on a darkweb auction - and the department of human services still hasn’t fully implemented all the recommendations of an independent review into access controls of Medicare data
The sale of Medicare card details highlights concerns over the implementation of health data.
An independent review of access to Medicare card numbers, released in 2017, said that Medicare card numbers, like those sold on the dark web, are “an important component of Australia’s proof of identity processes”.
“The Medicare card can be used to help verify an identity and, like any evidence of identity credential, is therefore susceptible to theft for identity fraud and other illicit activities,” the report says.
“Illegally obtained Medicare card numbers could also potentially be used for fraudulent Medicare claiming or to enable ineligible individuals to access Medicare funded health services.”
It notes that sale of Medicare data could “reduce public confidence in the security of government information holdings, such as the My Health Record system”.
Privacy concerns have been abundant throughout the implementation of My Health Record.
Shared cybersecurity risk was an area that the Australian National Audit Office found “disappointing” about the My Health Record rollout, specifically around sharing information with healthcare providers and other third parties.
A journal entry mentions the sale of the AFP commissioners' Medicare details
The AFP said in the released case notes for Operation Elaphiti that it was was aware of public backlash around this issue.
“With the changes earlier this year to My Health Record from an opt in to an opt out system, and the ensuing media coverage, vulnerabilities within the Medicare system are highly likely to attract significant political and media interest.”
Operation Elaphiti
The AFP had been investigating Alphabay since 2017 following reports that Medicare data was being sold on the site.
According to the AFP documents, “up to 160 Medicare numbers were suspected to have been accessed unlawfully”.
The redacted documents show that agents executed search warrants in relation to the vendors who were selling Medicare data, but it does not appear as though any arrests were made.
Like the infamous Silk Road, Alphabay was a site trading in black market materials – including data from high profile hacks.
Alphabay was shut down in mid-2017 after a US law enforcement operation saw the arrest of alleged site operator Alexander Cazes who was found dead in his Thai prison cell days later.
Operation Elaphiti was suspended in June last year before shortly being reactivated after more sales were spotted.
The AFP agent’s journal notes that in September last year a new marketplace had opened up and was selling Medicare details.
Although the AFP was “aware of new advertisements” on this new site – presumably of Medicare information – the police were “reluctant to pursue due to resources”.
Official case notes mention that, due to the “scale of offending it would not be in the public interest to allocate further resources to the investigation”.
https://ia.acs.org.au/article/2019/poli ... k-web.html
Police Medicare details for sale on dark web Sites used to traffic personal data of high-profile feds.
By Casey Tonkin on Dec 17 2019 11:28 AM
Former AFP commissioners had their personal data sold on the dark web. Image: Shutterstock
Three former Australian Federal Police (AFP) commissioners had their Medicare details put up for sale on the dark web.
Documents released through freedom of information (FOI) reveal that former AFP commissioners Mick Keelty, Tony Negus, and Andrew Colvin had their Medicare details placed on the now-defunct Alphabay marketplace.
An AFP spokesperson told the ABC that it knew the commissioners’ details had been up for sale, but did not know if any were ever sold.
Journalist Paul Farrell lodged the FOI request.
He has been following the dark web sale of Medicare information since buying his own card details off the dark web in 2017.
Paul Farrell · Dec 17, 2019
The department of human services has responsibility for the Medicare system but it won’t comment on what happened
Two years ago I bought my own Medicare card details on a darkweb auction - and the department of human services still hasn’t fully implemented all the recommendations of an independent review into access controls of Medicare data
The sale of Medicare card details highlights concerns over the implementation of health data.
An independent review of access to Medicare card numbers, released in 2017, said that Medicare card numbers, like those sold on the dark web, are “an important component of Australia’s proof of identity processes”.
“The Medicare card can be used to help verify an identity and, like any evidence of identity credential, is therefore susceptible to theft for identity fraud and other illicit activities,” the report says.
“Illegally obtained Medicare card numbers could also potentially be used for fraudulent Medicare claiming or to enable ineligible individuals to access Medicare funded health services.”
It notes that sale of Medicare data could “reduce public confidence in the security of government information holdings, such as the My Health Record system”.
Privacy concerns have been abundant throughout the implementation of My Health Record.
Shared cybersecurity risk was an area that the Australian National Audit Office found “disappointing” about the My Health Record rollout, specifically around sharing information with healthcare providers and other third parties.
A journal entry mentions the sale of the AFP commissioners' Medicare details
The AFP said in the released case notes for Operation Elaphiti that it was was aware of public backlash around this issue.
“With the changes earlier this year to My Health Record from an opt in to an opt out system, and the ensuing media coverage, vulnerabilities within the Medicare system are highly likely to attract significant political and media interest.”
Operation Elaphiti
The AFP had been investigating Alphabay since 2017 following reports that Medicare data was being sold on the site.
According to the AFP documents, “up to 160 Medicare numbers were suspected to have been accessed unlawfully”.
The redacted documents show that agents executed search warrants in relation to the vendors who were selling Medicare data, but it does not appear as though any arrests were made.
Like the infamous Silk Road, Alphabay was a site trading in black market materials – including data from high profile hacks.
Alphabay was shut down in mid-2017 after a US law enforcement operation saw the arrest of alleged site operator Alexander Cazes who was found dead in his Thai prison cell days later.
Operation Elaphiti was suspended in June last year before shortly being reactivated after more sales were spotted.
The AFP agent’s journal notes that in September last year a new marketplace had opened up and was selling Medicare details.
Although the AFP was “aware of new advertisements” on this new site – presumably of Medicare information – the police were “reluctant to pursue due to resources”.
Official case notes mention that, due to the “scale of offending it would not be in the public interest to allocate further resources to the investigation”.
https://ia.acs.org.au/article/2019/poli ... k-web.html
-
Juliar
- Posts: 1355
- Joined: Wed Dec 28, 2016 10:56 am
Re: Medicare FRAUD crackdown
Now to get back on the REAL issue - FRAUD.
Mr Hunt's spokesman said anyone with evidence of Medicare fraud should contact the government's health provider compliance tip-off line on 1800 314 808.
Health insurers call for federal crackdown on public hospital 'fraud'
By Dana McCauley December 11, 2019 — 8.45pm
Health funds are calling on federal health minister Greg Hunt to use the government's new data-matching powers to stop public hospitals from rorting patients with private health insurance by allowing inexperienced doctors to treat them instead of their chosen specialist.
Private Healthcare Australia chief executive Rachel David said funds had evidence suggesting some public hospitals are ripping off members by admitting them as private patients – which entitles them to a doctor of their choice by law – only to have a junior doctor treat them.
Private health funds say some public hospitals are defrauding Medicare and ripping off patients.CREDIT:ALAMY
"It's important for the sake of the patient coming in that they get the treatment they are entitled to, and that they've paid for," Dr David said.
The federal government passed legislation to establish a new Medicare data-matching scheme on the last sitting day of the year, giving the health department expanded access to health information, with the aim of recovering more from almost $2 billion worth of non-compliant health claims each year.
Dr David said the funds had handed Mr Hunt evidence of public hospital fraud after noticing a discrepancy between their claims data and Medicare Benefits Schedule gap claims for private patients in public hospitals, showing an irregularly high number of claims for some specialists.
"We have anecdotal evidence that specialist provider numbers are being used by junior doctors at the insistence of the hospital to process more patients and get more private patients through the door," she said.
"Where someone's using a provider number and the specialist isn't present, it is [Medicare fraud]."
Mr Hunt told Parliament in October his department had found "instances of fraudulent Medicare billing where either the doctor or the patient for a service billed to Medicare was actually out of the country when the service was supposed to have been provided".
The health funds' compliance push aims to slow the trend of public hospital staff convincing patients with insurance to be admitted privately, even though they are entitled to be treated for free – which they say is driving up their costs and making it difficult to keep a lid on premiums.
Mr Hunt has raised his concerns about the growth in private patients being treated in public hospitals with state and territory health ministers.
A spokesman for the minister said the Morrison government would pursue "hospital admission arrangements that ensure that public hospitals do not induce patients to use their private health insurance when they are entitled to receive the same care for free".
Australian Private Hospitals Association chief executive Michael Roff on Wednesday called for an end to public hospitals "coercing privately-insured patients to use their insurance in the public hospital", blaming the trend for a spike in elective surgery waiting lists.
Australian Institute of Health and Welfare data released on Wednesday showed 890,000 patients joined public hospital elective surgery waiting lists in 2018-19, with only 760,000 patients admitted for surgery over the period – leaving 130,000 waiting.
Mr Roff said public hospitals were "pushing [private patients] ahead in the elective surgery queue, leaving Australians who rely on the public system to wait even longer".
A spokesman for the NSW health department said the state's hospitals "do not prioritise treatment of insured patients over non-insured patients".
"Treatment of a patient in a NSW public hospital, or the scheduling of a patient for elective surgery, is based on clinical need regardless of health cover," the spokesman said.
"NSW public hospitals fully inform patients of the financial implications of choosing to use their private health insurance ... [including] full disclosure of any out-of-pocket costs."
Victorian health minister Jenny Mikakos said "rising premiums and junk products" were "driving patients away from the private health system and onto public waiting lists".
Mr Hunt's spokesman said anyone with evidence of Medicare fraud should contact the government's health provider compliance tip-off line on 1800 314 808.
https://www.smh.com.au/politics/federal ... 53j0d.html
Mr Hunt's spokesman said anyone with evidence of Medicare fraud should contact the government's health provider compliance tip-off line on 1800 314 808.
Health insurers call for federal crackdown on public hospital 'fraud'
By Dana McCauley December 11, 2019 — 8.45pm
Health funds are calling on federal health minister Greg Hunt to use the government's new data-matching powers to stop public hospitals from rorting patients with private health insurance by allowing inexperienced doctors to treat them instead of their chosen specialist.
Private Healthcare Australia chief executive Rachel David said funds had evidence suggesting some public hospitals are ripping off members by admitting them as private patients – which entitles them to a doctor of their choice by law – only to have a junior doctor treat them.
Private health funds say some public hospitals are defrauding Medicare and ripping off patients.CREDIT:ALAMY
"It's important for the sake of the patient coming in that they get the treatment they are entitled to, and that they've paid for," Dr David said.
The federal government passed legislation to establish a new Medicare data-matching scheme on the last sitting day of the year, giving the health department expanded access to health information, with the aim of recovering more from almost $2 billion worth of non-compliant health claims each year.
Dr David said the funds had handed Mr Hunt evidence of public hospital fraud after noticing a discrepancy between their claims data and Medicare Benefits Schedule gap claims for private patients in public hospitals, showing an irregularly high number of claims for some specialists.
"We have anecdotal evidence that specialist provider numbers are being used by junior doctors at the insistence of the hospital to process more patients and get more private patients through the door," she said.
"Where someone's using a provider number and the specialist isn't present, it is [Medicare fraud]."
Mr Hunt told Parliament in October his department had found "instances of fraudulent Medicare billing where either the doctor or the patient for a service billed to Medicare was actually out of the country when the service was supposed to have been provided".
The health funds' compliance push aims to slow the trend of public hospital staff convincing patients with insurance to be admitted privately, even though they are entitled to be treated for free – which they say is driving up their costs and making it difficult to keep a lid on premiums.
Mr Hunt has raised his concerns about the growth in private patients being treated in public hospitals with state and territory health ministers.
A spokesman for the minister said the Morrison government would pursue "hospital admission arrangements that ensure that public hospitals do not induce patients to use their private health insurance when they are entitled to receive the same care for free".
Australian Private Hospitals Association chief executive Michael Roff on Wednesday called for an end to public hospitals "coercing privately-insured patients to use their insurance in the public hospital", blaming the trend for a spike in elective surgery waiting lists.
Australian Institute of Health and Welfare data released on Wednesday showed 890,000 patients joined public hospital elective surgery waiting lists in 2018-19, with only 760,000 patients admitted for surgery over the period – leaving 130,000 waiting.
Mr Roff said public hospitals were "pushing [private patients] ahead in the elective surgery queue, leaving Australians who rely on the public system to wait even longer".
A spokesman for the NSW health department said the state's hospitals "do not prioritise treatment of insured patients over non-insured patients".
"Treatment of a patient in a NSW public hospital, or the scheduling of a patient for elective surgery, is based on clinical need regardless of health cover," the spokesman said.
"NSW public hospitals fully inform patients of the financial implications of choosing to use their private health insurance ... [including] full disclosure of any out-of-pocket costs."
Victorian health minister Jenny Mikakos said "rising premiums and junk products" were "driving patients away from the private health system and onto public waiting lists".
Mr Hunt's spokesman said anyone with evidence of Medicare fraud should contact the government's health provider compliance tip-off line on 1800 314 808.
https://www.smh.com.au/politics/federal ... 53j0d.html
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