Medicare and Centrelink
Medicare and Centrelink TRACEY NEARMY

Rockhampton mother falls victim to alleged Medicare fraud

MEDICARE fraud not only puts a strain on the taxpayer, it prevents people accessing vital health services.

One Rockhampton mother was unable to get her 9-year-old daughter an Aboriginal Health Care Assessment because Medicare claimed she'd already accessed one despite her never receiving the service.

Melanie Light didn't realise the false claim had been put through until November 2015 when she tried to get the health check through the Bidgerdii van that came to her daughter's school.

"The school had a van from Bidgerdii to do a health check and I put her name down to get the check and they said they couldn't do it because it had already been done,” Melanie said.

"You're only allowed one a year and she'd apparently already had it.”

Melanie asked the medical centre where her daughter allegedly received the health check why a service she hadn't received was accessed with her Medicare number, but they were uncooperative.

"I went to [medical practice name withheld] and the last time she'd been to the doctors was February (2015) for a medical certificate... and that's all that was done,” Melanie said.

"Apparently that's when the health check occurred.

"I said I want the check done, you've billed Medicare for it.”

Melanie was told by the medical centre they couldn't help her and it was a Medicare issue, so she took the next step and submitted a fraud complaint.

Medicare told Melanie her complaint wasn't the first they'd received, but after her initial contact she never heard anything back.

"They were pretty good, they just said it wasn't the first complaint they heard,” Melanie said.

"They just said [medial practice name withheld] had billed them so they reimbursed it.

"I was supposed to get a call back but I never ever did.

"I just wanted to know what was going on and why she couldn't have her health check.”

Due to the fraud claim never being finalised, Melanie's daughter had to wait until February to get this important health check which costs $260 without Medicare support.

The Australian Government Department of Health was unable to comment on Melanie's fraud claim, but said complaints of this nature were taken seriously as taxpayers were affected.

"The Australian Government Department of Health takes all allegations of fraud very seriously,” a spokesperson said.

"The department investigates each case where evidence suggests an offence may have taken place.

"These types of crimes involve taxpayers' money, and this is simply not something that can be taken lightly.

"The department works in close partnership with police authorities and if criminal prosecution is warranted, we refer matters to the Commonwealth Director of Public Prosecutions.

"The department will make an example of people defrauding the taxpayer.”

In 2015-2016, the Department of Health received 3203 tip-offs from members of the public and healthcare providers regarding potential fraud with 35 of these cases being referred to the Department of Public Prosecutions with a value of $888,558.

The total amount of debts recovered from incorrectly paid benefits in this time was $18.6m.

So far, from 2016 to 2017, 13 cases have been referred to the Department of Public Prosecutions, totalling $197,945.

The Department of Health encourages members of the public, healthcare professionals and their staff to report behaviour they suspect to be fraudulent.

If you think you have been a victim of fraud, you can submit a suspected case through the department's website,

Alternatively, you can phone The Department of Human Services fraud tip-off line on 131 524, Monday to Friday.

To clarify this story, the Bidgerdii Community Health Service was at no time involved in the fraudulent claim, and did the right thing by highlighting the problem.

The business involved in the incident was not named while investigations are underway.

Bidgerdii encourages people to access the Aboriginal Health Care Assessment service as part of their provision of health and wellbeing to the Aboriginal and Torres Strait Islander community.

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