Medicare Rorts

Billions of dollars are being rorted from Medicare each year, including by billing dead people and falsifying patient records to boost profits.

Medicare — Australia's universal health insurance scheme — is one of the most important social programs in the country. But Adele Ferguson's investigation for ABC 7.30 and The Age/Sydney Morning Herald revealed that the scheme was being systematically exploited by a small number of practitioners who were billing for services never rendered, billing for deceased patients, and falsifying records to maximise their claims.

The investigation drew on data analysis, whistleblowers from within the health sector, and interviews with former Medicare officials who described a system that was designed to pay claims quickly and with minimal scrutiny — creating an environment in which fraud could flourish.

The scale of the problem was staggering. Estimates suggested that billions of dollars were being lost to Medicare fraud each year — money that could have funded hospitals, nurses, and genuine patient care.

The investigation found that the Department of Health's compliance mechanisms were inadequate to detect the full scale of the fraud. Practitioners who were billing at rates far above their peers were rarely investigated, and those who were found to have committed fraud often faced minimal consequences.

The broadcast prompted the government to announce a review of Medicare compliance mechanisms and to commit additional resources to fraud detection — but critics argued that the response was inadequate given the scale of the problem.