I’ve been in contact with medical providers in my home state of Queensland, as well as with the AMA Queensland branch, and they’ve raised a number of disturbing issues with me. The first issue I want to raise with you is that the department appears to have sent out letters to practice managers in relation to concerns about billing practices. In those letters—and I have one here—it says: “If irregular or suspected fraudulent behaviour is identified, DVA will institute measures to ensure ongoing compliance, including the referral of matters to regulatory bodies and/or the Australian Federal Police for investigation.”
Can you understand how a medical practice that is dealing with your department, seeking clarification on numerous matters, and not getting that clarification, could feel aggrieved when they receive a letter that potentially refers them to the Australian Federal Police? Do you think that’s the right approach to deal with medical practitioners who, in many cases, are making personal sacrifices to provide medical care to our veterans?
Respondent
Thank you for the question, Senator. I’ll commence, and then I’ll hand to my colleague, who can provide more detail. I would say that in those letters, we are providing relevant information to medical professionals. We are not saying that we are referring them; we are providing advice about what options are available to the department. That section refers to an escalation process at the end of the letter. I would also advise the committee that we have, in fact, referred some medical professionals to AHPRA and to the AFP. We are merely advising medical professionals that this has occurred. We are not saying to the people who receive those letters that this is happening to them; we are providing information on what occurs when we are not satisfied that processes are being followed.
Senator Scarr
Just on that point—and we’ll get to the further answer—but in relation to this specific letter: this is a letter to professionals who are providing a service. I put it to you that in the first instance, when you are seeking clarification, there should not be any mention in a one‑page letter of referrals to the Australian Federal Police. You should simply seek clarification on the matters in question, rather than mention referrals to the police. The impact of that letter is demonstrated by the fact that it has been raised with me by medical practitioners who feel aggrieved. Will you take that on board? Will you take on notice the fact that there may be a better approach than including references to the Australian Federal Police in initial correspondence?
Respondent
Certainly, Senator. I would also like to take on notice whether that letter is, in fact, the first letter. It may well be. I know we have sent previous correspondence, but I don’t know whether colleagues at the table have further information. Yes—so that is something we would look at, Senator, and it may be that the letter you are holding up is not the first letter issued.
Respondent
Senator, as the Secretary has noted, there are a range of measures we can take when we have concerns about the behaviour of medical providers. As acknowledged in the opening statement, the majority of providers who work with us are doing the right thing. However, as you know from evidence in other sittings of this committee, we have recently had concerns about the behaviour of some providers—whether relating to amounts charged or the quantum of tests ordered—and we have taken regulatory action accordingly.
I think I know, from the way you introduced the matter, which provider you are referring to. I will not name them; you have not. What I can say is that there have been significant discussions since that letter, including within the last few weeks. There is guidance in our treatment notes and documents for doctors engaging with our system. DVA has needed to be more active in recent times, and as part of that education process, we outline the range of options open to us, including referrals where appropriate. Clearly, those referrals are not our first or only response, but signalling the depth of concern we may have is important, as with all Commonwealth agencies.
Senator Scarr
I don’t think that’s the most constructive approach. My next question is: does DVA pay the same fee to all providers for compensation medical assessments?
Respondent
In the last few weeks, Senator, we have published updated guidance on reasonable fees. However, fees in that context are not determined in the same way as treatment fees.
Senator Scarr
Okay, so let me repeat the question: does DVA pay the same fee to all providers for compensation medical assessments?
Respondent
No, Senator. It is not a prescribed fee.
Senator Scarr
Why?
Respondent
The statutory basis is that the department is required to pay reasonable fees. Guidance has been updated, but that part of the system does not have prescribed fees in the way the treatment system does.
Senator Scarr
So why is the department paying different fees for compensation medical assessments undertaken by different providers?
Respondent
Senator, in a sense we pay the bills presented along with the claims. It is our obligation under the Act to pay those.
Senator Scarr
Why are you paying fees on a differential basis—paying different providers different fees for compensation medical assessments?
Respondent
Senator, as I have described, they are not prescribed fees.
Senator Scarr
I didn’t say they were. I said you are paying different fees for compensation medical assessments undertaken by different providers. Correct?
Respondent
That’s correct.
Senator Scarr
Why?
Respondent
That has been a feature of our system for some time, Senator. I’ve explained the basis on which we do it.
Senator Scarr
I’m sorry—you have not explained the basis. With respect, saying “it has been a feature of the system for some time” is probably the worst possible explanation I could receive. This issue has been raised with me by the AMA Queensland. The department is providing different providers with different fees for compensation medical assessments, and I’m asking: why?
Respondent
We have recently issued guidance to address that issue and provide a range the department considers reasonable. Where assessors can demonstrate that an assessment is more complex, or additional measures were undertaken, the department can pay above that guidance if it is demonstrated to be justified.
Respondent
We would need to look at specific examples, but we do pay differentials based on short consultations, long consultations, and per‑page report fees. So the differences may relate to the structure of the guidance.
Senator Scarr
I have been told—by people providing these services—that particular large providers are being paid more than smaller providers under contracts entered into with them. Is that the case?
Respondent
There are no contracts for compensation assessments, Senator, other than the one the department holds. Veterans can go to whichever doctor they choose. We do not have multiple contracts with compensation assessment providers. We have one contract with MLCOA for independent medical examinations, which are used in specific circumstances. The vast majority of assessments are undertaken by medical professionals who are not under contract to the department.
Senator Scarr
So you’re not aware of the concern among providers that their clients—many of whom they’ve treated for a long time—are actually pressured to go to MLCOA? Are you aware of that concern?
Respondent
We can provide more information, Senator.
Senator Scarr
Ms Frame, are you aware of that concern?
Respondent
I am, Senator. Yes.
Senator Scarr
So why do people have that concern?
Respondent
I wouldn’t express it in the terms you have, Senator—that they are “pressured” to go to MLCOA. We can discuss the parameters under which the department requests an assessment with MLCOA.
Respondent
There are two circumstances. One is where a veteran cannot find a doctor; in that case we can refer them to MLCOA.
Senator Scarr
I’m talking about circumstances where they’ve had a long‑term relationship, and the medical practitioners are telling me their clients are being pressured to go to MLCOA.
Respondent
Senator, there have been circumstances—particularly recently—where we have had concerns about the veracity of reports or where we are seeing complex claims with multiple conditions. In those cases, we have referred veterans for an independent medical examination. I would not describe that as “pressure”. It is where the department decides an independent assessment is necessary.
Our preference is that reports are provided by treating doctors. However, it has also been the practice of certain providers to deliberately divert veterans away from their treating doctors and toward commission‑based advocacy services.
Senator Scarr
It appears that different rates are paid in certain circumstances. What is the current range of fees the department pays for compensation medical assessments? And what factors determine those differences? Feel free to take that on notice.
Respondent
Senator, we might table the schedule I referred to earlier, which includes distinctions in consultation length and other factors.
Senator Scarr
Just to be clear: DVA does not hold contracts with medical providers at different rates for compensation assessments?
Respondent
Senator, to give you a clear answer: we have two sets of contractual arrangements with doctors. One is with MLCOA for independent medical examinations. The other is with Bupa, for internal medical advice to delegates. We do not have contracts with other treating doctors.
