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.
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