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

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

3. 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

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

5. 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

6. 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

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

9. 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.”

10. 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

12. 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

13. 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

14. 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

15. 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

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

17. Identified
38%
33%
Identified
Re-identified
Re-identified

18. ‘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???

19. (The Advertiser, 30 Sept 2010)

20. 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

21. 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

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