Documents obtained under Freedom of Information laws show some pathology companies made potentially "opportunistic" claims to bill extra flu and RSV tests to Medicare during the pandemic.
They also show cases where pathology companies were operating state-government funded pop-up and drive-through testing clinics —These state-based centres were already half-funded by the federal government under a national partnership agreement, so billing Medicare in full was a cost-shift to the Commonwealth.
Peak body Australian Pathology chief executive Liesel Wett said its members were subject to routine compliance audits and there was no evidence of rorting. Professor Duckett said that quantity of calls to a departmental hotline should have set alarm bells ringing.In a statement however, a spokesman for the federal department of health said the 47 tips only made up about 1 per cent of the overall tips it received during the height of the pandemic.
Sydney mother-of-three Kate, who didn't want to use her surname for privacy reasons, said her son's results showed he was also tested for influenza A and B and RSV after attending a drive-through clinic in November 2020. Health economist Professor Stephen Duckett said the documents showed "systematic rorting on a very large scale".
Kate's son's results showed he was also tested for influenza A and B and RSV after attending a drive-through clinic in November 2020.The documents show that in response to these compliance concerns the Department of Health and Aged Care wrote letters to nine pathologists and four pathology companies in October and November 2020 "reminding them … that tests needed to be clinically relevant to be claimed through Medicare".
"The department does not assume non-compliance from data alone. Generally, there is a need to assess additional information with the rendering health professional, testing provider or state government," it said. By January 2022 there had been approximately 27.8 million bulk-billed COVID-19 tests nationally since the start of the pandemic, at a cost of around $2.3 billion to Medicare.The documents do indicate the department sent warning letters to up to seven pathology companies at different stages, and there are only seven companies who are members of peak body Australian Pathology and two are IVF companies — which suggests non-compliance was widespread.
The figures above show how profits in the pathology sector surged from large scale COVID testing during the pandemic.