The Department of Health and Ageing failed to consider integrity risks, including scope for provider fraud, when it introduced telehealth in response in to Covid-19, an audit has found.

The audit also found the effectiveness of telehealth as a pandemic response hasn’t been ‘coherently’ evaluated.

A report from The National Audit Office released on Thursday found shortfalls in governance, risk management and evaluation after Health expanded telehealth services in 2020, in what was billed as the most significant structural reform to Medicare in the national heath insurance scheme’s history.

More then 280 temporary telehealth MBS items were created between March and May that year. At January 2022, 211 items were permanently retained.

Between April and June 2020, 16.5 per cent of MBS services were provided via telehealth.

The ANAO report says the expansion was ‘partly supported by sound implementation arrangements’.

However, Health failed to adequately evaluate the telehealth expansion, which included consideration of risks to the integrity of the scheme.

Not in line with risk management policy

The government’s policy advice on temporary telehealth failed to consider risks, Auditor Grant Hehir says, and wasn’t in line with its risk management policies.

“In the urgent timeframe of the initial pandemic response, Health advised the Minister for Health on the costs, but only some of the benefits and risks of temporary telehealth policy settings,” the report says.

“Health did not manage implementation risks associated with temporary or permanent telehealth changes in accordance with its risk management policy.

Health did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, prior to implementing the temporary and permanent MBS telehealth items

Auditor General Grant Hehir

“Health did not conduct a risk assessment of integrity risks, such as provider fraud and non-compliance, prior to implementing the temporary and permanent MBS telehealth items.”

The report says action against non-compliant doctors was ‘limited’, however “corrective non compliance treatments were applied to a subset of providers .. and focused on the most egregious non-compliance behaviours.”

Fraud

Between March 2020 and July 2022 Health detected 600 potentially non-compliant or fraudulent behaviours, of which 23 related to telehealth. Seven of those were assessed and four were approved for ‘treatment’ – which can range from a warning to a criminal investigation.

The ANAO also examined a spreadsheet of tip-offs received between 13 March 2020 and 30 June 2021 alleging inappropriate MBS claiming in relation to telehealth.

The spreadsheet identified 137 tip-offs that warranted further examination. As of August 2022, 76 of these cases had been ‘treated’, 59 had been evaluated and closed without treatment, and two remained under evaluation.

Lack of performance measures

Health also failed to establish performance measures for telehealth expansion or develop an evaluation plan for the further use of remote health services.

“Health did not plan for performance monitoring or evaluation of temporary or permanent telehealth,’ the audit says.

“Performance monitoring of the temporary telehealth expansion was limited and lacked measures and targets that could inform judgements about performance, and there was no evaluation that could assist with the design and implementation of potential expansions to telehealth during future emergency conditions.”

In a statement to Government News, the AMA said Telehealth was a positive addition to Australia’s health system.

“We continue to work with the government and department of health to refine it,” it said.

Comment below to have your say on this story.

If you have a news story or tip-off, get in touch at editorial@governmentnews.com.au.  

Sign up to the Government News newsletter