Calls to waive dentists' debts to Medicare

Parliament house flag post

Calls to waive dentists' debts to Medicare

Posted 19/04/2012 by Amanda Biggs

On 19 March 2012, the Opposition health spokesman the Hon. Peter Dutton, introduced the Health Insurance (Dental Services) Bill 2012 into the House of Representatives. The Bill was also introduced into the Senate on 21 March by Senator David Bushby, and immediately referred to the Senate Finance and Administration Committee for inquiry. The Bill proposes to 'redress past and future inequities that have arisen from the operation of subsection 10(2) of the Health Insurance (Dental Services) Determination 2007' (the Determination). This Determination prescribes the arrangements which allow dentists, dental specialists and dental prosthetists to provide Medicare funded services (capped at $4250 over two years) to patients with chronic conditions as set out under the Chronic Disease Dental Scheme (CDDS). The Opposition and the Greens also supported a Senate motion on 21 March 2012 calling on the Government to waive debts of dentists.

The 'inequities' referred to in the Bill, and which also form the substance of the motion, centre around Medicare Australia's (MA) attempts to recoup payments made to non-compliant dentists. The ‘inequities’ arise when a dental practitioner who has provided a legitimate service is required to repay the Medicare benefit because of an administrative failure. An audit undertaken by MA has revealed that a number of dentists failed to comply with the rules of the CDDS and were in breach of the Determination. In evidence to a Senate Estimates Committee in February this year, also reported in the media, the Department of Health and Ageing advised that of the 89 dentists audited so far a majority had delivered the services they billed to Medicare. However, 63 were deemed non-compliant due to administrative breaches, such as not completing appropriate paperwork or providing patients with quotations. Another 12 were found to be non-compliant due to a failure to actually provide a service.

The CDDS was introduced and implemented during the last few months of the Howard Government. It expanded a more limited scheme first introduced in 2004, which provided for capped dental benefits of $220 a year. This scheme had lower than expected uptake, as the Parliamentary Library Bills Digest on the legislation to establish the CDDS explains. The CDDS expanded the range of Medicare refundable services available to patients, broadened the eligibility criteria, and increased the cap to $4250 (over two years).

The number of services provided under the expanded scheme subsequently rose dramatically, as did expenditure. As an earlier Parliamentary Library paper notes, between the introduction of the CDDS in November 2007 and August 2008, over 818 000 services were provided at a cost to government of $133.8 million. This compared to a total of just 16 000 services provided at a cost of $1.8 million under the original scheme's three year lifespan. Originally forecast to cost $384.6 million over four years, the CDDS has now cost in excess of $2.3 billion, according to expenditure figures available through the Medicare database (see benefits under Medicare category 9).

Concerns around the CDDS emerged early, including concerns around the cost of the scheme, equity issues, rorting allegations, and the fact it failed to target the most financially needy. Suggestions to improve the scheme were made. These included means testing, limiting the range of services, tightening eligibility criteria, and expanding the scope of practice to include dental hygienists and therapists.

Labor had already announced during the 2007 election campaign it would close the CDDS which it regarded as failed, and redirect funds to its promised Commonwealth Dental Health Program and Teen Dental Plan. But efforts to close down the CDDS once Labor formed government were blocked a number of times by the Senate as this Parliamentary Library paper notes. Consequently, the CDDS has continued to operate. However, reports of rorting and fraud persisted, culminating in the audit action by MA.

The Health Insurance (Dental Services) Bill 2012 aims to ensure that dentists who have provided a legitimate service but have failed to comply with the Determination are not required to repay Medicare payments they received. The Bill makes clear that only those dentists who failed to either give patients in writing a treatment plan or quotation, or provide written copies to the referring GP, would benefit from the enactment of this Bill. The Bill requires the responsible Minister , alone or in conjunction with other Ministers to either: amend the original Determination in line with the provisions in Schedule 1 of the Bill; waive the Commonwealth's right to payment; provide for act of grace payments; redress the inequity through the income tax system; or take any other action necessary to redress the inequity. Further, the Bill requires the Minister to present a report to Parliament on the action taken. Schedule 1 outlines the amendments that are to be made to the Determination, if amending the Determination is the chosen course of action.

Regardless of the fate of this Bill, close scrutiny of the CDDS, including continuing with the audit program, is likely. Examples of serious breaches that have already emerged from the audit, such as accepting a payment when a service has not been provided, would suggest such scrutiny remains justified. However, calls on the Government to waive debts where dentists have failed to comply with administrative requirements, are likely to continue. Legislative provisions may redress some of the problems of the CDDS, but arguably, problems of non-compliance should be addressed through industry consultation and education programs.

Meanwhile, the CDDS continues to face an uncertain future, not likely to be known until Budget night. But, as many advocates have long argued including in this report from the National Advisory Council on Dental Health, the need for improved access to dental services and a comprehensive approach to oral health promotion and disease prevention remains.

Thank you for your comment. If it does not require moderation, it will appear shortly.
Facebook LinkedIn Twitter Add | Email Print


Flagpost is a blog on current issues of interest to members of the Australian Parliament

Parliamentary Library Logo showing Information Analysis & Advice




refugees asylum immigration Australian foreign policy Parliament elections climate change social security women welfare reform taxation Indigenous Australians Australian Defence Force welfare policy school education higher education private health insurance health financing emissions trading Middle East Senate Australian Bureau of Statistics employment people trafficking Asia statistics illicit drugs gambling health reform federal election 2010 Australian Public Service income management Medicare disability Sport United Nations environment industrial relations constitution transport politics criminal law Afghanistan health forced labour food public service reform aged care aid Australian Sports Anti-Doping Agency World Anti-Doping Agency United States federal budget Carbon Pricing Mechanism dental health international relations governance regulation Fair Work Act voting law enforcement electoral reform OECD Australian Electoral Commission WADA child protection poker machines Australia in the Asian Century steroids National Disability Insurance Scheme detention 43rd Parliament slavery health system leadership domestic violence parliamentary procedure International Women's Day accountability defence capability multiculturalism ASADA Australian Federal Police labour force people smuggling debt New Zealand Australian Crime Commission pharmaceutical benefits scheme political parties coal seam gas Human rights crime China Census election results UK Parliament Papua New Guinea banking corruption pensions children's health Aviation federal election 2013 foreign debt gross debt net debt Senators and Members ALP Newstart Parenting Payment Youth Allowance sea farers United Kingdom energy food labelling Australian economy violence against women vocational education and training military history by-election High Court skilled migration mental health Federal Court terrorist groups science social media Higher Education Loan Program HECS federal state relations youth paid parental leave same sex relationships customs planning doping health risks Gonski Review of Funding for Schooling sex slavery Special Rapporteur Northern Territory Emergency Response social policy ANZUS Rural and regional trade unions Foreign affairs election timetable Indigenous royal commission Productivity firearms public policy Population ADRV terrorism transparency research and development welfare ASIO intelligence community Australian Security Intelligence Organisation carbon tax mining employer employee renewable energy regional unemployment fishing European Union family assistance United Nations Security Council forestry Drugs welfare systems Indonesia children Constitutional reform local government codes of conduct terrorist financing homelessness Parliamentary remuneration money laundering Trafficking in Persons Report social inclusion paternalism environmental law US presidential election nutrition ODA Defence sitting days electoral divisions Southeast Asia administrative law universities TAFE Ireland citizenship asylum seekers early childhood education Canada Financial sector national security fuel disability employment Tasmania integrity standards NATO Australian Secret Intelligence Service sexual abuse World Trade Organization Australia public health housing affordability bulk billing water health policy Governor-General US economy export liquefied natural gas foreign bribery question time speaker superannuation public housing expertise climate Intergovernmental Panel on Climate Change Department of Agriculture Fisheries and Forestry Pacific Islands reserved seats new psychoactive substances synthetic drugs UNODC carbon markets animal health middle class welfare constitutional recognition of local government referendum consumer laws PISA competition policy US politics language education baby bonus Leaders of the Opposition citizen engagement policymaking Australia Greens servitude Trafficking Protocol forced marriage alcohol entitlements ministries Hung Parliament social citizenship maritime Iran regional students school chaplains federal budget 2011-12 salary Medicare Locals primary care Building the Education Revolution Turkey Syria marine pollution sustainability prisons police deaths in custody electoral margins electoral pendulum electoral redistribution redistribution NSW redistribution WA redistribution ACT electoral boundaries ASEAN Sustainable Development Goals Double dissolution Senators safety vehicles MYEFO Pathology tertiary education Taiwan Xi Ma meeting family violence government financial advisers financial planners Financial System Inquiry Murray Inquiry China; Economic policy; Southeast Asia; Africa housing Speaker; House of Representatives; Parliament High Court; Indigenous; Indigenous Australians; Native Title ACT Indigenous education Norfolk Island External Territories emissions reduction fund; climate change child care funding refugees immigration asylum procurement Indigenous health e-voting internet voting nsw state elections 44th Parliament 2015 ABS Age Pension Death penalty capital punishment execution Bali nine Bali bombings Trade EU China soft power education Fiji India Disability Support Pension Antarctica Diplomacy by-elections state and territories Bills anti-corruption fraud bribery corporate ownership whistleblower G20 economic reform innovation Members of Parliament Scottish referendum Middle East; national security; terrorism social services Criminal Code Amendment (Misrepresentation of Age to a Minor) Bill 2013 online grooming sexual assault of minors ACT Assembly smoking plain packaging tobacco cigarettes Asia; Japan; international relations Work Health and Safety Migration; asylum seekers; regional processing China; United States; international relations fiscal policy Racial Discrimination Act; social policy; human rights; indigenous Australians Foreign policy Israel Palestine asylum refugees immigration political finance donations foreign aid Economics efficiency human rights; Racial Discrimination Act employment law bullying Animal law; food copyright Australian Law Reform Commission industry peace keeping contracts workplace policies same-sex marriage disorderly conduct retirement Parliament House standing orders prime ministers First speech defence budget submarines workers Somalia GDP world heritage political engagement leave loading Trade; tariffs; safeguards; Anti-dumping public interest disclosure whistleblowing Productivity Commission limitation period cancer gene patents genetic testing suspension of standing and sessional orders live exports infant mortality honorary citizen railways disciplinary tribunals standard of proof World Health Organisation arts international students skilled graduate visas temporary employment visas apologies roads Italy national heritage NHMRC anti-dumping Rent Assistance obesity evidence law sacrament of confession international days DFAT UN General Assembly deregulation Regulation Impact Statements small business Breaker Morant regional engagement social determinants of health abortion Members suspension workplace health and safety marine reserves hearing Victoria astronomy resources sector YMCA youth parliament Korea rebate Australian Greens presidential nomination Racial Discrimination Act political parties preselection solar hot water Financial Action Taskforce Horn of Africa peacekeeping piracy Great Barrier Reef Stronger futures political financing political education Social Inclusion Board early childhood National Quality Framework for Early Childhood Education and Care Murray-Darling Basin sanctions Norway hospitals republic President Barack Obama Presidential visits qantas counselling Korean peninsula Work Choices biosecurity hendra federalism federation preselection therapeutic goods Therapeutic Goods Administration plebiscites computer games pests suicide nuclear COAG Ministerial Councils floods ADHD stimulant medication advertising electricity extradition conscience votes poverty preventative health rural health coastal erosion Parliamentary Budget Office work-life balance

Show all
Show less
Back to top