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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Lessons from the ‘legitimate’ misuse of Medicare Benefits Schedule Item 45503

Jonathon Bruce Ryan https://orcid.org/0000-0003-0349-028X A B C D *
+ Author Affiliations
- Author Affiliations

A Discipline of Surgery, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.

B Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, NSW 2031, Australia.

C Department of Cardiothoracic Surgery, Prince of Wales Private Hospital, Sydney, NSW, Australia.

D Department of Cardiothoracic Surgery, Eastern Heart Clinic, Sydney, NSW, Australia.

* Correspondence to: j.ryan@unsw.edu.au

Australian Health Review 48(3) 254-258 https://doi.org/10.1071/AH24073
Submitted: 7 March 2024  Accepted: 14 March 2024  Published: 4 April 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

This Perspective begins with a case study that raises two important questions: who is responsible for the existence of non-compliant Medicare billing, and who is responsible for eliminating it? In the discussion that follows, I argue, first, that the problem has been created by individual clinicians and by Medicare itself (i.e. the organisational structure that administers Medicare). Second, and more importantly, I argue that the ethical obligation to eliminate the problem extends more broadly to include both the government and the medical profession.

Keywords: ethics, governance, healthcare fraud, health funding and financing, health policy, Medicare, Medicare Benefits Schedule, organisational culture.

References

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