ADA backs Senate over Medicare audits


The Australian Dental Association Inc. (ADA) has welcomed the Senate passing a motion requiring the Federal Government to detail the Medicare audits of dentists who have provided dental care as part of the Chronic Disease Dental Scheme (CDDS). Bite reported on the Senate request here. Dr Shane Fryer, President of the ADA says that the Association has had serious concerns with the Scheme since its implementation, and more recently, the overzealous manner in which Medicare audits have been conducted on dentists who have provided care to patients within the Scheme.

“The ADA feels that the Government should be instructing the Medicare auditors to stop pursuing dentists who have provided quality care to patients within the Scheme but who have made errors in completing some of the administrative requirements of the Scheme,” Dr Fryer says.

The ADA states that aggressive action taken over absent paperwork and the financial claims Medicare has lodged against a number of dentists has placed dentists under financial strain and potentially the threat of bankruptcy, despite patients receiving the care they needed.

“From the outset, the ADA advised the Government that the Scheme was seriously flawed. The ADA’s recommendation was that a targeted dental scheme delivering services to disadvantaged patients was the most effective model for public dental care,” says Dr Fryer.

This CDDS was implemented by the Howard Government to provide dental care to people with chronic conditions and complex care needs. Patients gain eligibility to access dental care under the Scheme through their medical GP.

Medicare statistics indicate that to-date the Medicare claim made by dentists for each patient has averaged less than half that limit or about $2,000 per dental treatment plan.

Importantly, the majority of dentists participating in the Scheme simply tried their best to fulfil the patient’s dental needs but did not meet the administrative requirements correctly. Legitimate, quality dental care and treatment has been provided to people with chronic disease.

“The advice on the Scheme provided by Medicare to dentists has been unclear. Dentists were confused about the administrative requirements,” states Dr Fryer.

The ADA has raised its concerns with the Government and senior Medicare officials regarding the manner in which the Medicare audits have been undertaken and stated that dentists have not been treated fairly in the audit process.

“Rather than deal with any issues around dentists not fulfilling their administrative requirements at the time of the Scheme’s implementation through an educative or conciliation process, Medicare has waited two years after the dental care was delivered to pursue recovery of monies. Due to this relentless pursuit, we now see dentists threatened with bankruptcy or closing their practices,” says Dr Fryer.

While the ADA does not support inappropriate conduct in any way by dentists, the Association has reservations about the motivation for the Medicare audits.

“When the Government first launched the Scheme, the ADA advised the Government that it had failed to recognise the extent of the need for dental services in the community and that the budget allocation would need to be revised.

This advice was not heeded and the budgetary allocation was clearly inadequate. The ADA questions if this is the real reason for the Medicare audit campaign that is underway,” states Dr Fryer.

The Association states it has and will continue to demand that Medicare’s claims for recovery of fees paid to dentists only be further pursued where there has been some serious and blatant breaches of the Scheme—not merely an administrative error as has been the case to-date.


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