Key Points
Private health insurers and a federal health regulator are investigating specialist doctors for incorrectly billing patients under "no-gap-fee" arrangements.
Patients are urged to check their health records.
National Seniors says the scandal is further evidence the private health care system is failing and needs to be reviewed.
Evidence continues to mount that our private health system is not fit for purpose and must be reviewed from head to tail to find out what's wrong and fix it.
If the Federal Government needed any more reason to act, news that private health insurers are investigating some specialist doctors for defrauding patients should be more than sufficient.
Private health insurance holders continue to face a never-ending cycle of premium increases, product limitations, and soaring out-of-pocket costs. Now, there are allegations that they could be ripped off through fraudulent and illegal billing practices.
This follows claims from a whistleblower that some specialist doctors have been systematically defrauding patients, health funds, and Medicare for personal financial gain.
In a document tendered by the whistleblower they state:
"I am sure this is only the tip of the iceberg and hope you people … in high place[s] will stand up to this toxic culture, which blatantly preys on retired, helpless people ... who take up private health insurance in good faith only to be taken advantage of."
Health insurers have been notified of allegations against nearly 50 doctors in Victoria. The specialists are mostly anaesthetists and surgeons, as well as an obstetrician and gastroenterologist. They have been accused of charging patients extra fees of up to $5,000 while agreeing to participate in "no-gap-fee" arrangements with health insurers in which they bulk-bill and pocket rebates from Medicare.
The private health insurance system is failing its customers, especially older people, who have little choice but to stick with it, pay higher costs, because the alternative of relying on the public system could be even worse.
You can read our research into what older people think about private health insurance here
