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News Bulletin : ADA News Bulletin May 2011
3 MAY 2011 MEDICARE AND THE CHRONIC DISEASE DENTAL SCHEME 'GET YOUR HOUSE IN ORDER' You will have seen numerous previous reports of ADA's dealings with Medicare Australia (MA) over the last 15--20 months where the ADA has advised you as to how important it is for you to comply with the administrative requirements and rules with the Chronic Disease Dental Scheme (CDDS). MA has undertaken an exhaustive investigation of some dentists' claims under the CDDS. These investigations commenced with MA either receiving a tip off about a dentist's treatment or billing, or from a direct complaint by a patient to MA about a dentist's conduct in respect of treatment under the Scheme. Investigations are at various stages from initial informal enquiries to those that have escalated to full blown audits. These investigations initially revealed widespread non-compliance with the administrative requirements of the CDDS and instances of pre billing of services by dentists. Non-compliance from the administrative perspective dealt primarily with a failure to meet Section 10 requirements, which obligates the dentist: • prior to the commencement of the course of treatment, to provide a written treatment plan to the patient, along with a written itemised quotation for services within the plan, and • prior to the commencement of the course of treatment, to provide a copy or summary of the treatment plan to the referring General Practitioner (GP). These obligations exist whether the patient is being bulk billed or not. Provision of advice to the patient is designed to provide informed consent and financial consent for treatment. Provision of the treatment plan to the medical GP is designed to assist them to develop and monitor the overall treatment plan for the chronically ill patient. If Section 10 of the Scheme was not complied with, the claim against MA for the services rendered is invalid and MA has a right to recover the monies it has paid in respect of those services. The law is absolutely clear on this. The ADA has been in frequent dialogue with the Ministers for Human Services, (currently the Hon. Tanya Plibersek), the Department and the Compliance Officers with MA. What the ADA has attempted to do in its approaches to Government is to seek the assistance of the Minister and MA in having the breaches in the CDDS administrative compliance requirements with respect to Section 10 sympathetically dealt with by MA in its recovery actions. The ADA has recognised that in many cases non-compliance was innocent due to lack of familiarity and education with the CDDS. (I want to make it clear that this is not about protecting those few who may have acted unprofessionally in claiming under the Scheme but is aimed at the larger group who may not have completed the administrative requirements in the correct sequence and are therefore in breach of the legislation.) Initially, it was believed that MA was strictly seeking recovery for all dental benefits paid pursuant to invalid claims, however, after meeting with Medicare and outlining our concerns it is now evident that MA is adopting a more reasonable approach. Recent dialogue with MA has seen a further slight adjustment in its stance on Section 10 breaches. Following our most recent meeting with MA officials on Tuesday, 12 April I would like to advise members of the following matters: • If you receive a request by MA to undertake an examination of your treatment records for patients treated under the CDDS, you should seek advice from your Branch and discuss with the Branch whether you have been compliant with the Scheme both now and in the past. • As part of standard operating arrangements, MA officials indicate they will engage with you throughout the audit process, this may be by phone, letter and/or face-to-face. These opportunities are used to seek information, keep you informed of progress and allow you to move through the audit as efficiently as possible. • If in this investigative process you assess or are advised that you have been non-compliant then you should determine in what areas this has occurred and after further consultation with your Branch consider seeking MA's advice as to how to best address the issues identified. • Cooperation with MA may be in your best interests. F. Shane Fryer Federal President president's comments "...all practitioners who have been involved with the CDDS should get their house in order, review their records and correct all administrative discrepancies."
ADA News Bulletin April 2011
ADA News Bulletin June 2011