One Nation leader Pauline Hanson says Medicare is being "rorted" by up to A$3 billion a year, and that "a lot of this could be prevented" by requiring photo ID on Medicare cards.
But where did this $3 billion figure come from? And would putting photos on Medicare cards really help claw back billions a year in taxpayer dollars?
In Hanson's own words , "Please explain".
What is One Nation proposing?
One Nation suggests putting a photo on every Medicare card would make it harder for people to fraudulently use another person's card to access subsidised medical care.
The party's website also mentions its concern about other examples of Medicare fraud . These include medicines funded by the Pharmaceutical Benefits Scheme being obtained and then sold on, and doctors billing Medicare for appointments that never happened.
Medicare is taxpayer-funded , and every dollar lost to fraud is a dollar not spent on patient care. But the cure One Nation proposes runs into a problem from the start.
The party's own examples of fraud describe quite different things. A patient using someone else's card is an identity problem. A doctor billing for an appointment that never happened is a provider-compliance problem. While a photo on your card may catch the first, it does nothing about the second.
This distinction matters, because the $3 billion a year figure One Nation leans on is not an estimate of Medicare card fraud, or even an estimate of deliberate fraud.
It bundles fraud with a much broader category of " non-compliance ", which covers a range of things including incorrect claims from unintentional billing errors to deliberate deception.
Where did the $3b figure come from?
The figure comes from the 2023 Independent Review of Medicare Integrity and Compliance , known as the Philip Review .
The government commissioned this review after a period of intense debate about non-compliant Medicare billing. This was sparked by PhD research that concluded non-compliant billing was driven mainly by the complexity of the Medicare system, rather than deliberate fraud by doctors, who were left trying to comply with rules they could not understand.
The Philip review noted the available data are too weak to measure Medicare fraud and non-compliance with precision. Even so, the review stated it is " entirely feasible " that $1.5-$3 billion is lost each year to a combination of Medicare fraud and non-compliance.
That covers a wide spectrum of behaviour. For example, it can mean a doctor mistakenly claiming the wrong Medicare item, billing unnecessary or repeated services, deliberately billing more expensive services, or claiming for a service that was never provided.
The review does not single out individuals misusing Medicare cards. Most examples given relate to provider billing behaviours, intentional or unintentional.
It also does not conclude $3 billion a year is being deliberately "rorted".
What's wrong with the photo ID solution?
A photo on a Medicare card helps confirm the person holding the card is the one named on it. It is not a solution for the range of non-compliance issues the Philip review identifies.
These range from criminal fraud at the extreme end to honest billing errors at the other. It talks about the complexity of the claiming system, a lack of clarity on compliance rules, limited decision support to help providers bill correctly and a lack of continuous monitoring.
This is because Medicare is a third-party payer system . A patient receives care, a provider bills, and the Commonwealth pays. Almost everything that goes wrong happens between the provider and the payer. Patients also have little visibility over what is billed in their name.
Photo ID cannot help providers work out which item numbers to claim, whether a service was necessary, or help spot odd claiming patterns across thousands of providers.
Photo ID is unlikely to deter Medicare fraud on the scale we saw in a $7.5 million Melbourne case in 2024. This involved stolen identities of Medicare providers and bogus bank accounts.
Photo IDs are also costly. Reissuing photo cards to 27.5 million Medicare customers would require a large, certain expense set against an uncertain marginal benefit. Back in 2019, rolling out photo ID on Medicare cards was costed at half a billion dollars .
What are some solutions?
The Philip review made several recommendations to address Medicare non-compliance. Many are not catchy enough to fit on a campaign poster, including:
improving governance: including establishing a Medicare integrity oversight committee, bringing together agency stakeholders and independent experts to improve risk reporting and monitoring
simplifying and redesigning billing rules and support systems: including reducing the number of ways to claim, providing guidance at the point of claim, and improving post-payment investigations
strengthening provider education: increasing education for practitioners, providers and administrative staff on Medicare claiming requirements, and giving continuous feedback so mistakes are caught early
modernising technology and data systems: introducing continuous claims monitoring, pre-payment checks and stronger data links to identify unusual or non-compliant claiming and to allow analysis of patterns across the whole population.
In response to the review, the Australian government funded and set up a taskforce to advise on improving Medicare integrity.
Since 2023, the taskforce has changed the law to strengthen compliance and auditing, introduced claiming controls to stop incorrect billing, built data models to find fraud and non-compliance faster, and published a plain-English handbook to help providers with billing.
Two bills passed parliament in 2025 to tighten up the system further.
All these actions target the claiming and compliance issues the Philip review identified, on the provider and system side.
None of these actions puts a photo on a card, because nothing in the evidence suggests this would help.
Anam Bilgrami does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
