BILLS;Health Insurance (Dental Services) Bill 2012 [No. 2];Second Reading – 21 Jun 2012

I rise to speak on the Health Insurance (Dental Services) Bill 2012. This private senator’s bill is a flawed bill about a flawed scheme. Senator Bushby should be embarrassed to have this bill tabled in the Senate. I think Senator Kroger said she thought the dental schemes and health schemes were decaying, but in response to that there are plenty of holes in this bill.

Before I go on to what is wrong with this bill, which is no more than a political stunt by the opposition, I will take some time to talk about the Chronic Disease Dental Scheme and what a shambles it was. The CDDS was introduced in the dying months of the Howard government, as we know, after they scrapped the Keating government’s state funding for services targeting those on low incomes, introduced in 1994. We have heard Senator Ryan’s arguments on why the coalition scrapped that, but they could have continued to fund it and they chose not to. The CDDS provides up to $4,250 in Medicare benefits for dental services over two consecutive calendar years to eligible patients who have a chronic medical condition or complex care needs. The patient must be referred by their general practitioner for dental services, and their oral health must be impacting on or likely to impact on their general health.

While this all sounds reasonable and good, it is a scheme that has been poorly targeted in terms of addressing the genuine dental needs of Australians, and it has been open to misuse. To give senators a few examples of why this scheme was flawed, I offer the following. The CDDS, as we have heard from speakers on this side before, is not means tested. This means that millionaires can get up to $4,250 worth of free dental treatment at taxpayers’ expense; and, because the scheme is not targeted, this treatment could include cosmetic dental work such as caps and crowns. Some of the misuses of the scheme include unnecessary crowns, ordering dentures that do not fit—as we have heard from previous speakers—and dentists charging the full $4,250 without completing the work.

More than 1,000 complaints have been lodged about the CDDS, demonstrating that it is a flawed and poorly targeted scheme. That is why the Labor government have been trying since 2008 to shut the scheme down, but we have not been able to get the legislation through the Senate. This is a scheme that had just under $400 million budgeted for it over the forward estimates from the 2007-08 budget, yet at the end of January 2012 total expenditure on the scheme has been a staggering $2.3 billion. That is right: $2.3 billion. So not only is it a flawed scheme that was badly targeted but the cost of the scheme has massively blown out.

If we could free up the money for this flawed scheme, we could provide investment in dental services where it is really needed, because we all know that it is difficult for Australians in rural and remote areas to access dental services. This is why the Gillard Labor government are already making a targeted investment of just over $500 million over four years to improve the oral health of Australians who are least able to afford dental care. This funding includes a public dental waiting list blitz delivered through a national partnership agreement with the states and territories, the development of a national oral health promotion plan, the expansion of the Voluntary Dental Health Graduate Year Program, funding for a graduate year program for oral health therapists, rural and remote infrastructure and relocation grants for dentists, and funding to non-government organisations to coordinate pro bono work by dentists for the most disadvantaged Australians across the country. Of course, we could be doing a lot more for the oral health of Australians who really need it if the opposition would get out of the way and help us close down this flawed scheme.

I will get back to Senator Bushby’s bill. We know there have been problems with dentists meeting the requirements of the scheme; we do not deny that. Currently, the Department of Human Services has identified some $21 million for recovery, of which around $260,000 has been repaid so far. Some dentists have claimed that they were not adequately advised of their responsibilities before the scheme commenced. But, once the scheme commenced, there were many pieces of correspondence and advice explaining what was required of dentists. To put this in context, $21 million has been identified for recovery out of a total of $2.3 billion spent on the overall scheme—

Senator Bushby interjecting

 Senator BILYK: and there was adequate notice given through pieces of correspondence and advice, once the scheme commenced, explaining what the details of the scheme were. The requirements of the scheme are not onerous, and the government have notified dentists of these requirements on nine separate occasions—nine separate occasions. Let me make it clear, though, that, while there are some cases of inappropriate claims and fraudulent claims, I understand that there are cases of dentists generally not complying with the administrative requirements of the scheme, even when their treatment has been delivered in accordance with the scheme. I know this because my office has had several representations from at least one of these dentists, who has a significant debt to the Commonwealth. However, I do not believe that in all these cases dentists should be excused from the requirements of the scheme. Most of the non-compliance cases arise from a failure to meet two simple requirements, and they are to provide the patient with an upfront statement of the costs of the treatment and to provide the patient with a treatment plan outlining what work the dentist is undertaking. The Department of Human Services made it clear that it considers these to be core requirements of the scheme.

Dentists gave evidence to the inquiry into the bill by the Senate Finance and Public Administration Legislation Committee explaining why they considered these requirements to be important. As one dentist submitted:

One rule in particular—namely the provision of an itemised treatment plan and written quotation before treatment begins—is a fundamental safeguard that must be upheld rigorously to ensure the provision of (1) good medicine, (2) patient acceptance, (3) provider compliance, and (4) transparency for audit and complaint resolution purposes. This is no different from the underlying expectation the Dental Board of Australia places on dental practitioners to provide services to privately paying patients in this country.

So what Senator Bushby proposes to do with this bill is establish ignorance as an excuse for noncompliance with the law, but it also directs the Minister for Health to undertake actions that are the responsibility of other ministers.

If we examine each of the decisions the Minister for Health can make under clause 6 of the bill in respect of a CDDS debt, we can see how sloppily assembled this bill is. For example, the bill allows the minister to provide for the Commonwealth to waive its right to payment of debts arising under the Health Insurance Act in relation to dental services. It is unclear how this provision would work in practice, given that under the Financial Management and Accountability Act only the minister for finance can waive debts to the Commonwealth. The bill also allows the Minister for Health to make acts of grace payments. However, under the Financial Management and Accountability Act, an act of grace payment is one which would not otherwise be authorised by law or required by statutory command or required to meet a legal liability. So there is an inherent contradiction in proposed section 6(1)(c) of the bill.

The committee noted that there was fairly extensive evidence given by the Department of Human Services about the extent to which they had gone to educate dentists about their obligations under the scheme, and the department provided the committee with examples of documents where the requirements of the CDDS were made very, very clear.

While dental practitioner groups, such as the Australian Dental Association, indicated to the committee that they were supportive of Senator Bushby’s bill, the Australian Medical Association had some very good grounds for opposing it. It is ironic that this bill refers to the liability of non-compliant dentists as an inequity, when the AMA submitted that it is the bill itself that would create inequity. The AMA did not support exonerating one class of medical practitioners—that is, dentists—when it comes to meeting their legal requirements when billing Medicare items. Quoting the AMA’s submission:

We do not consider it appropriate that dentists can use ‘I did not know’ as a defence against future non-compliance with the Determination. Nor do we consider it appropriate for Parliament to provide this defence by passing the Bill, particularly as we are not aware that this defence exists in any other Commonwealth law.

Now, the Minister for Human Services, Senator Kim Carr, is aware of the issues that dentists have with Medicare’s approach to compliance with the CDDS and has made the very sensible decision to have a retrospective look at the compliance arrangements. This approach, announced by the minister during budget estimates a few weeks ago, is much more sensible than that proposed by the ridiculous bill currently before the Senate. So Minister Carr will ask the department to look through each of the 66 noncompliance cases on a case-by-case basis and in some cases a new conclusion may be reached. But let us make one thing clear: this is not a free pass for dentists. It should be recognised that there are noncompliance cases where dentists have flagrantly breached their administrative and patient care obligations and some cases where dentists have even charged the government for services that were never provided. I would like to think that those on the other side would not support that sort of behaviour.

I reiterate that it remains the government’s intention to close down the CDDS and replace it with a national dental scheme that is targeted to the Australians who need it most. I am confident that, through our negotiations with the Greens and the Independents, we can secure such a scheme. Consequently, I hope we can secure the support we need to shut down this shambolic scheme that is a remnant of a failed Howard government which did nothing in 12 years of government to address the real needs of Australians on public dental waiting lists.