Senator Alan Eggleston



Health Insurance (Dental Services) Bill 2012

This is a very important debate, because many elderly people in this country do have really severe oral health problems, and unfortunately very often they are not able to have those problems fixed because they simply cannot afford the cost of dental treatment. If you can imagine what it is like to live with rotten teeth, not being able to chew properly and with ulcers in your mouth, you would, I think, agree that the lot of such people—and they are the ones I am referring to—is pretty miserable.

The whole purpose of this scheme, which was introduced by the now Leader of the Opposition, the then Minister for Health, Tony Abbott, was to provide a means by which elderly people in the community who needed dental and other oral health treatment could obtain that treatment through the Medicare system. I think it is quite outrageous that the government is seeking to stop this scheme and is alleging fraud against dentists when, in fact, it seems that the communication between the Department of Health and Ageing and the dental profession was very poor and that dentists very often innocently made mistakes for which they are now being charged with having created a fraud. This is just an absolute nonsense and I totally support the remarks of Senator Ronaldson in that regard.

The other thing I would say is that this government has a habit of curtailing debates on the health sector. For some reason the government feels very sensitive about health issues. Towards the end of the last sitting before the winter recess, I was to speak on the National Health Amendments (Pharmaceutical Benefits Scheme) Bill 2012. I say that 'I was to speak', because I did not get the opportunity to do so. The government rudely guillotined the debate, preventing a number of my colleagues and me from making comments on that bill.

Today, we debate the Health Insurance (Dental Services) Bill 2012 [No.2] which is a bill based on a misconception that dentists were defrauding the scheme when, in fact, it seems the Department of Health and Ageing and the government were at fault for their failure to communicate the essential features and requirements of the scheme adequately to the dental profession.

This Chronic Disease Dental Scheme, introduced in the last months of the previous coalition government, allows eligible patients to claim up to $4,250 in Medicare benefits for dental services in any two consecutive calendar years. Over 17 million services have been provided to approximately one million patients since 2007. That speaks for itself in quantifying the specific need for a scheme like this to ensure that the mostly elderly patients who are in this cohort are able to obtain dental treatment so that their quality of life can be improved.

Dental care items were introduced in the Medicare Benefits Schedule in 2004 for patients with chronic conditions and complex care needs under the former enhanced primary care arrangements—again, an initiative of the Howard government. Sadly, as I have said, the need for this kind of service remains but this government appears to be determined to curtail it as much as possible.

In May 2007, significant changes to the EPC program were announced in the budget, to take effect from 1 November in the same year. Eligible patients under that scheme, introduced by the Howard government, could then claim up to $4,250 a year in Medicare benefits for dental services in any two consecutive years. The scheme has been a great success, as I have said, despite two attempts by the Rudd government to shut it down for purely political reasons. One must really question the motivation, the principles and the sense of responsibility of those in the Rudd government who sought to shut down this scheme, and which, fortunately, were rejected twice by the Senate. So, the scheme remains in place.

In June 2010, Labor established an audit task force after its initial attempts to close the scheme failed. These audits are primarily focussed on 'incorrect claiming'—which has also been described as fraud and which it is not—associated with legislative requirements found in section 10 of the Health Insurance (Dental Services) Determination 2007. The coalition supports a transparent and appropriate audit process to detect cases of fraud, misuse of taxpayers' funds or the provision of inappropriate services. However, under Labor's audit processes, dentists have been found to be noncompliant and action has been pursued against them for minor technical mistakes with paperwork, which has been misrepresented as fraud. In most cases, the dentists caught by the audit process have provided appropriate services to patients in need but merely did not comply fully with the technical requirement to provide medical general practitioners with copies of treatment plans and quotations for services prior to commencing treatment.

Why, one might ask, would the dentist not provide these treatment plans if that was a requirement? It seems that a lot of the responsibility for this lies with the government. It seems that consultation with the dental profession as such was almost nonexistent. Instead of sitting down with the dentists, who are not used to working with Medicare in the same way that doctors are, the government did not sit down and consult with the dental profession and make a point of the fact that there was a need to provide the referring general practitioner with a treatment plan. Dentists are certainly well versed in the Department of Veterans' Affairs system and very conversant with its requirements but they have not had the same degree of exposure to Medicare and its requirements as medical practitioners. So it is not really surprising that many dentists inadvertently did not send copies of their treatment plans to the referring doctors.

An interesting comment from the Australian Dental Association is that, from the doctors' point of view, they wrote to the dental association saying that they saw no point in dentists sending them treatment plans because the medical GPs were not dentists and the treatment plans actually meant very little to them. In effect, the government says the dentists were guilty of fraud because they did not sent treatment plans to the general practitioners and it seems the general practitioners really did not think these were particularly useful because they did not understand the treatments proposed.
More broadly, the education of the dental profession about this scheme was not comprehensive. When the CDDS was introduced, dentists did not in many cases pay due regard to the detailed requirements of this scheme. The only interaction between the profession was delivery of a letter, a copy of the Medicare benefits fee schedule and some reference to website information.

Clearly inadequate information was provided by the Department of Health and Ageing to the practitioners. As the Australian Dental Association noted, it was not until deficiencies in the education program provided by Medicare were recognised in early 2010 that any more detailed and clear information was provided. Since then, the Australian Dental Association have regularly updated its membership on compliance issues. Obviously, the ADA, as one would expect from a responsible, professional organisation, do not like to see its members accused of committing frauds, for very large amounts of money in some cases, when they were simply providing a much-needed service to very needy patients under the Medicare system.

Some of the sums which have been stated to have been obtained by fraudulent means by some dentists under this scheme run into millions of dollars—extraordinary amounts of money. But I am advised by dental practitioners that the implication that individual dentists were charging these huge sums of money is quite wrong and that, in fact, these very large sums of money reflect the services provided by group dental practices, who naturally see a lot of patients and ran up very large accounts and submitted those to Medicare for payment, but not in any individual capacities. So they represent group practices—many dentists, not single dentists.

Again, I come back to this issue of the lack of communication between the department of health and Medicare and the dental profession. As I understand it, the dentists have now sought to inform the Australian Dental Association of the compliance requirements of reporting back to the referring practitioner. That is a development in recent times and I think, if anything, it underlines the good faith of the Australian dental profession in seeking to remedy the flaws which existed in the information provided by the health department to the dental profession in the way this scheme was to be run.

I think it is absolutely outrageous that the government have, in effect, sought to defame the dental profession for committing frauds within this scheme, when in fact the real faults were that there was very little consultation by Medicare with the profession and there was no attempt to hold educational seminars with dentists to explain the detailed reporting requirements of this scheme. For the government to go from there to claiming that dentists who provided services to people who have a very real and, if you like, a sad need for improvements in their dental and oral health is quite outrageous. The people affected here are mostly elderly and mostly could not afford dental treatment. They went to the dentist in good faith, had their treatment provided in good faith, and now the dentists who provided that treatment are accused of rorting the system.

The whole record of this Labor government has been to curtail medical services provided to the people of Australia through the Medicare system by restricting the listing of new drugs. Now we find they are trying to shut down a scheme which has provided a very important service to a very vulnerable group of people in our community. If I was on the Labor side of either the House of Representatives or the Senate, I would hold my head in shame. It is quite a disgusting thing from my point of view that the needs of these elderly people who have been provided with dental treatment under this dental services plan should now face the possibility that these services will be withdrawn.

I hope that the Senate makes sure that this legislation is passed and that the government are made to feel guilty and ashamed of their attempts to restrict the service. It is a very good service. The flaws lie with the government and government departments, as I have said, in failing to communicate the key reporting requirements to referring general practitioners. The dental profession have never had a requirement to do that in the past, and the fault very much lies with the government. Their opposition to this bill is very, very hypocritical.

Posted in: Speeches
Actions: E-mail | Permalink |

Contact Dr Alan Eggleston

Email me

Working for Western Australia
© Senator Alan Eggleston 2012 | Authorised by Senator Alan Eggleston, 26 Charles Street, South Perth WA 6151 | Datasearch website design | Login