PHA: 'Unusual pattern' resulting in additional revenue

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Private Healthcare Australia has taken the unusual step of providing a formal notification to the Medical Board of Australia regarding the conduct of a medical practitioner.

The Medical Board of Australia (Board) has a range of responsibilities, including the registration of medical practitioners and medical students, as well as developing standards, codes and guidelines for the profession. It also investigates notifications and complaints about medical practitioners and, where necessary, conducts panel hearings and refers serious matters to Tribunal hearings.

Private Healthcare Australia said it has provided evidence to the Board alleging an unusual pattern of certifying patients as needing hospital care for professional attendances, resulting in significant additional revenue for a health service provider.

The association did not provide any detail on the case. However, according to its director of policy and research, Ben Harris, “Where one person or one service is manipulating the system to maximise their income, that comes at a cost to families paying health insurance premiums, hurts ethical providers and stifles innovation. It’s vital everyone in the industry works together in an ethical and sustainable manner to improve patient care and we all have an obligation to call out this behaviour.”