The big health rip-off revealed
A SECRET fee “bible” used by doctors to set rates for common medical procedures has revealed a massive overcharging scandal, with some specialists demanding 10 times the recommended Medicare fee.
The Sunday Territorian has obtained the Australian Medical Association’s List of Services and Fees, used by doctors to set their rates for more than 8700 common procedures.
And their greed is plain to see – some are charging 10 times more than what it recommends – contributing to the more than $1.6 billion a year in gap payments not covered by health funds or Medicare.
The peak doctors’ group has for years refused to make the fee list public and in doing so has made it impossible for patients to understand if their doctors’ fees were reasonable. But today we lift the lid on a massive overcharging scandal by showing that many doctors are charging even in excess of these higher AMA fees.
IT’S the document doctors don’t want you to see.
The secret fee bible that recommends specialists charge up to three times more than the Medicare fee for thousands of hospital procedures can be revealed for the first time.
News Corp has obtained the Australian Medical Association’s List of Services and Fees, used by doctors to set their rates for more than 8700 common procedures.
And their greed is plain to see – some are charging 10 times more than what it recommends, contributing to the more than $1.6 billion a year in gap payments not covered by health funds or Medicare.
The peak doctors’ group has for years refused to make the fee list public and in doing so has made it impossible for patients to understand whether their doctors’ fees were reasonable.
Today we lift the lid on a massive overcharging scandal by showing that many doctors are charging even in excess of these higher AMA fees.
Our investigation has found more than 15,000 patients have had to draw down more than $290 million in superannuation to fund these exorbitant medical bills and other out-of-pocket expenses.
Industry data shows money-hungry surgeons are stripping pensioners of their retirement nest eggs, charging them massive out-of-pocket fees of over $20,000 for deep brain stimulation for Parkinson’s disease and $10,000 for hip and knee replacements.
Plastic surgeons are among the worst offenders, with some charging fees of $25,000, 10 times the AMA rate, for breast reductions.
Cancer patients are being preyed on by doctors charging gaps of $12,000 for breast reconstructions or over $10,000 for robotic prostatectomies.
Almost four in 10 privately insured women are deciding to have their babies in public hospitals because they can’t afford the $13,000 in out-of-pocket fees charged by private obstetricians.
The highest out-of-pocket costs are for hip and knee surgery; urology; and ear, nose and throat surgery.
Worse even than this, News Corp has been told some doctors are breaking the health fund rules by charging patients secret gap fees they tell them to keep hidden from their health funds.
This “shadow billing” occurs because patients of doctors who charge high fees that exceed health fund limits can’t access the health fund’s gap scheme payments.
To maximise the patient’s rebates, the doctor gives them two bills – one for the health fund that fits within its gap fee limits and a second, secret bill for thousands of dollars’ worth of gap fees.
News Corp was able to source a list of AMA fees for many common hospital procedures from health fund BUPA, which believes patients need better information so they can shop around to get the bestvalue health care.
“The No.1 concern we hear from our customers is the affordability of healthcare and their anger when they have an unexpected out-of-pocket cost,” said BUPA managing director Dwayne Crombie.
“If customers have to pay out-of-pocket gaps because a fee is high, then people question what benefit insurance provides them, without realising where the cost is coming from.”
Australian Medical Association president Dr Michael Gannon said, overwhelmingly, doctors didn’t actually charge their patients the AMA fee, “the vast majority use the insurers’ list of fees”.
And he explained the reason the AMA fees were up to three times higher than the Medicare fee was that they were indexed to inflation and wages growth but the Medicare fee was indexed at a much lower rate and had been frozen at 2014 levels for four years.
“If a doctor charges more than the AMA fee, they need to explain to their patients why that is the case,” he said.
Breast Cancer Network Australia chief Kirsten Pilatti said people wouldn’t buy a car without shopping around but often didn’t get a second opinion on their healthcare.
“We do know there are enormous variations in fees and we want full disclosure not just of surgeons’ fees but of all the other costs, including the anaesthetist and the assistant surgeon,” she said.
There is growing government concern about medical gap fees. Late last year, Health Minister Greg Hunt asked chief medical officer Brendan Murphy to investigate.
One of the solutions proposed was requiring doctors to list their fees on a public website so consumers could shop around for the best deal.