INSIGHTS: Joint statement on dental audits: ADA, Guild Insurance and Meridian Lawyers

Finally, some good news on the Medicare dental audits.

In recent developments, several ADA branch members received letters from the Department of Human Services (DHS) announcing full waivers of alleged debts arising from claims under the Medicare Chronic Disease Dental Scheme (CDDS) before 1 April 2010.

This follows the announcement by former Minister Kerr on 18 October 2012, that the DHS will facilitate applications for waiver of debt under the Financial Management Accountability Act 1997. The DHS announced it would support total waiver of ‘debt’ related solely to non-compliance with section 10 the Determination prior to April 2010. The DHS also announced it would give qualified support for waiver for non-compliance with Section 10 for claims after April 2010, if the dentist could show intent to comply within a reasonable timeframe after April 2010.

Following representation to Minister Kerr’s office, it was agreed that where the DHS was only proposing to seek a partial waiver of the alleged debt, the dentists would be given an opportunity to make submissions. Letters from DHS have started to trickle in advising of their intention to seek partial waivers and inviting submissions. We are yet to see what the DHS will interpret as a ‘reasonable timeframe’ for compliance after April 2010.

The full waiver of all alleged ‘debts’ arising from claims made prior to 1 April 2010 is an excellent outcome that was thought at times to be unachievable. It has been achieved in the face of unrelenting media alleging dentists were ‘rorting the system’ and in circumstances that have left many dentists questioning their support for publicly funded dental schemes.

It has occurred in the wake of the following political machinations:

• the intensive lobbying by dentists of local members of Parliament;
• collaboration between ADA Inc. and ADA State Branches to make representations to Ministers;
• the unrelenting and excellent efforts of Senator Bushby (Liberal Senator for Tasmania) at Senate Estimate meetings;
• in March 2012, the introduction of a Bill in Parliament by Senator Peter Dutton (Liberal Party). If passed, it would have required the Minister for Health to exercise a degree of forgiveness and not pursue recovery of alleged debt in circumstances where dentists were reasonably and innocently unaware of the Section 10 requirements;
• in May 2012, a Senate Inquiry Report that considered submissions from hundreds of dentists. ADA Inc. and ADA New South Wales attended the Inquiry and gave evidence. Whilst the majority of the Committee did not support the Dutton Bill, there was enough material in the report to embarrass the DHS going to issues of poor implementation and communication.

The excellent result has been achieved through:

• the loyalty and support of Guild Insurance in extending insurance cover to those audited by Medicare;
• the depth of support and efforts of ADA State branches;
• the tireless efforts of the team at Meridian Lawyers who were involved behind the scenes in agitating for legislative change, contacting parliamentarians, assisting with media releases, agitating for the Senate Inquiry and providing information to Senators for use at the Senate Estimates hearings; and
• the courage of practitioners such as Dr Wilma Johnson, Dr Dragan Antolos and Dr Helen Arabatzis, who constantly ‘fought the fight’ and who were brave enough to represent the profession in media circles.

The achievement to date has occurred after 3 years of hard effort. It is an achievement to be heralded and celebrated as a team effort.

If you have any questions, please get in touch with our Health Law team.