Doctor prescribed jail time for false Medicare claims
Date published
February 2020
Relevant impacts: Business impact and financial impact
A Queensland doctor was found guilty of defrauding Medicare out of more than $360,000. He used Medicare’s online system to lodge almost 4,000 false claims for providing services to patients who had died or on dates when he was overseas. The doctor owned four bulk-billing medical practices in Queensland at the time of the fraud. The man was sentenced to 4 years in prison. He was suspended from medical practice and might be deregistered or banned in the future.
Related fraudster personas
Related countermeasures
Use declarations or acknowledgments to both communicate and confirm that a person understands their obligations and the consequences for non-compliance. The declaration could be written or verbal, and should encourage compliance and deter fraud.
Verify any requests or claim information you receive with an independent and credible source.
Analyse data to improve processes and controls, increase payment accuracy and find and prevent non-compliance, fraud and corruption.
Match data with the authoritative source and verify relevant details or supporting evidence.
Services such as the Identity Matching Service can be used to verify identity credentials back to the authoritative source when the information is an Australian or state and territory government issued identity credential.
This countermeasure is supported by the Office of the Australian Information Commissioner's Guidelines on data matching in Australian government administration.
Audit logging is system-generated audit trails of staff, client or third-party interactions that help with fraud investigations.
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