AHIA Claims Leakage & Fraud Forum 2010 Hon Dr Michael Armitage Chief Executive Officer

Claims Leakage & Fraud Forum First class Conference in 2010 Excellent program / quality presenters AHIA Annual Conference

Political Overview PHI Industry’s position in the political environment High risk post 1 July 2011 Government reintroduce means-testing Bill Greens balance of power in Senate Green’s policy to abolish PHI Rebate Industry prepared for this scenario

Election 2010 PHI political issue in 2010 AHIA election ready Election activities: Leaders’ / Candidate letters Advertising / Media

Legislation 2009 AGM – Senate rejected means-testing   2009 AGM – Senate rejected means-testing 2010 AGM – Bill defeated for a second time (34-34: tied vote = defeat) Post election Minister Roxon confirms Government will reintroduce the Bill

AHIA Risk Assessment   Major project to develop risk assessment and Political analysis. Political & business risks facing the Industry under various election outcome scenarios Most likely: House of Reps ALP Green Senate

Election Activities Lobbying activities continue Liaise with political party secretariats Raise awareness of PHI with all candidates Seek policy positions on PHI

Political Response Coalition support – vote against means-testing Rebate Greens - “remove the Private Health Insurance Rebate and redirect the $3.8 billion to the public health system.” ALP - ”You may wish to raise this matter with the incoming government once the outcome of the election is known.”

AHIA Response The Greens target PHI Rebate AHIA advertising campaign: 15 Federal Electorates in weeks 3 & 4 ALP and Coalition electorates Newspapers and magazines Metropolitan daily newspapers

Key Messages 11.5 m Australians rely on PHI   11.5 m Australians rely on PHI Means-testing affects all Australians; pressure on public hospitals; pressure on premiums Benefits paid increased by 10%; premium increase 5.78% PC Report: Private is safer, shorter waiting times, higher productivity PHI not for rich: 5.6m less than $50,000 3.4m less than $35,000

PHI Industry 2011 Continue to convince legislators of PHI benefits Australian health model world class PHI delivers quality care for 11.5 m members Private health / Public good

AHIA Fraud Committee Difficult to quantify impact of Fraud Committee’s work No question it contributes to lower premiums Integrity of the PHI Industry Reduces waste Protects Govt investment (30% rebate etc) Sends a positive message to providers, consumers and industry opponents of PHI

What is fraud? Suspected unlawful activity by health care providers could include: billing for services not provided; up-coding duplicate billing for the same service inappropriate service delivery that may put the privately insured consumer at risk financially ... and more

Privacy and Fraud Health Care providers can hide behind privacy Knowingly using an inappropriate prostheses Knowingly perform unnecessary procedures = FRAUD

Identified 38% 33% Identified Re-identified Re-identified

‘Review of Joint Replacement Surgery and its Outcomes’ (NJRR 2006) Of 100 new components tested, none performed better than previously approved prostheses Latest information – Australia’s failure rate is 8% and Sweden’s is 6.8 % Wouldn’t 1.8% be better???

(The Advertiser, 30 Sept 2010)

Fraud Prevention Websites actively promote methods to reduce fraud Funds invest significant amounts of money in reducing the incidence of fraud on behalf of their members Websites actively promote methods to reduce fraud Don’t leave your card with the provider Check billing details on your receipt Check claims history regularly Report irregularities

Claims Leakage & Fraud Forum Industry professionalism Commitment to keeping premiums low Delivering quality care for our members = first class reputation Fraud prevention makes a major contribution

AHIA Claims Leakage & Fraud Forum 2010 Hon Dr Michael Armitage Chief Executive Officer