‘The [AMA] doth protest too much, methinks’

[The title of this Letter has been adapted from a classic Shakesperian quote].¹

I write in reply to the Letter by Looi and colleagues.² The authors have misrepresented themselves, misrepresented my article,³ and misrepresented the facts. In doing so, they have provided further evidence that the Australian Medical Association (AMA) is a bad faith actor in the ‘non-compliant Medicare billing’ debate.

Two of the authors failed to correctly declare their conflicts of interest.² Associate Professor Looi is an AMA Federal Councillor.⁴ Professor Bastiampillai is an AMA (SA) State Councillor.⁵ The authors also failed to declare that both references that they sought to rely upon were published by the AMA and that neither were subject to peer review prior to publication.^6,7 MJA Insight+ is a digital newspaper published by AMPCo, which is owned by the AMA.⁶ Canberra Doctor is a print magazine published by AMA (ACT).⁷

Looi and colleagues claim that I ‘conclude that clinicians, through potentially fraudulent activity, are the major causal agents of non-compliant billing’.² This claim is both false and misleading. My manuscript discussed how the permissive cultural attitudes of both individuals and societal actors contribute to the problem of non-compliant Medicare billing.³ I characterised doctors as rational actors, some of whom exploit the system and some of whom are exploited by the system.³ Moreover, the AMA was the actor whose normative behaviour I was most critical of.³

Looi and colleagues claim that ‘The paper appears to use unsupported rhetoric, e.g. ‘The Australian Medical Association responded reflexively to media coverage of Faux’s work with self-righteous indignation.’ (p. 256)’.² This claim is both false and misleading. Looi and colleagues have omitted the reference marker that appears in the published manuscript: ‘indignation.¹⁵’.^2,3 It links to a video recording of Professor Robson’s interview on the 7:30 Report on 21 October 2022,⁸ which allows readers to see for themselves that ‘reflexively’ and ‘self-righteous indignation’ are not unfair characterisations of his behaviour. For the record, a similar critique can be found in the Sydney Morning Herald Editorial from 18 October 2022: ‘The AMA’s leadership is in urgent need of a reality check’.⁹

Looi and colleagues’ claim, in relation to my use of Dr Philip’s A$1.5–3.0 billion estimate for the annual cost of non-compliant Medicare billing,¹⁰ that my ‘paper does not include the caveat to this estimate’.² They then misquote the Philip report to imply that Dr Philip thinks that his estimate is unreliable and that therefore it should not be relied upon.² The correct quote from the Philip report is that ‘This [estimate] comes with a significant caveat, in that there is real potential for the problem to scale to the order of magnitude in Dr Faux’ analysis should effective controls, systems and education not be put in place.’¹⁰ This is yet another example of the AMA falsely claiming that the Philip report vindicates their false assertion that non-compliant Medicare billing is not a significant problem.

Looi and colleagues should retract their Letter and apologise.

Ethics

This research did not require ethics approval as it did not involve people, medical records, or human tissues.