Medical Benefits Abuse Under Medicare

Abstract

ABSTRACT This paper examines the attempts of recent Federal governments to cope with the economic and political problems presented by medical benefits abuse under Medicare. Despite an intensive five-year parliamentary inquiry in the early 1980s, ongoing discussions with the medical profession, and an array of separate legislative and regulatory packages, medical fraud and overservicing has not been effectively contained. Indeed, while successive governments and the medical profession appear to be actively concerned with the problem, the available evidence strongly suggests that it has continued to expand, and remains particularly noticeable in the area of pathology services. The official response is that governments are doing as much as is legislatively and practically possible to minimise the extent of medical fraud and overservicing, and that there will always be ‘a few bad apples’ within the medical profession to ensure its continuation on a limited scale. This paper argues, however, that the very means by which governments have sought to alleviate the problem—and especially their central dependence on the cooperation and expertise of the organised medical profession—have not only exacerbated the problem, but have also induced its institutionalisation within the Australian health care system.