A convicted healthcare practitioner cannot reapply for registration for six years, after making 14,565 fraudulent Medicare claims totalling over $850,000
A registered medical practitioner has been found to have engaged in professional misconduct after being convicted in the County Court of Victoria on two charges of dishonestly obtaining Commonwealth property by deception.
These charges related to making 14,565 fraudulent Medicare claims totalling $854,188.20 between December 2006 and September 2013.
Over the nearly seven-year period, the Victorian doctor was found to have made false claims for services he had not provided, including in-home and nursing-home urgent after-hours attendances.
He was found to have used patient and family member details obtained from the Medicare cards of legitimate patients to claim fees for services not rendered.
False claims were lodged in batches as direct-bill claims, commonly referred to as bulk-billing.
The fraudulent conduct ceased on 10 September 2013 when Medicare investigators executed a search warrant at his home and seized his laptop computer.
In separate criminal proceedings, the doctor was found guilty of two criminal charges of obtaining property by deception and was sentenced to four years’ prison with a non-parole period of two years.
He was released on parole in November 2017.
The doctor was also ordered to make restitution to the Commonwealth of $834,188.20.
He has so far paid back approximately $20,000 of this amount.
The doctor, who was first registered as a medical practitioner in December 1998, has not been registered since September 2016 when his registration lapsed.
At a hearing this month, the Victorian Civil and Administrative Tribunal decided that the doctor had engaged in professional misconduct related to his criminal conviction.
It also found he had additionally engaged in unprofessional conduct by failing to give appropriate notice to the Medical Board of Australia that he had been charged with an offence punishable by 12 months’ imprisonment or more.
The Medical Board had received a formal response from the doctor, including admissions that his billing practices were inappropriate and his professional conduct was below the standard expected of a person in his position.
The doctor took full responsibility for the failure to report his criminal charges to the Medical Board, and stated that he is “acutely aware of” and acknowledged his mistakes and breach of trust.
He said the fraudulent conduct had started as a simple thing but then “snowballed”—he just kept doing it, and was oblivious to how much it was.
In cross-examination the doctor agreed that the amount defrauded was an “enormous” sum of money.
While the Tribunal acknowledged the doctor’s admissions, it concluded that “he offended out of greed and opportunism, and continued because he believed he would not get caught.
“As is clear, he only stopped when he was caught. We accept that he felt under financial and other pressures, but the pressures he described neither explained nor excused the conduct,” the Tribunal found.
“[The doctor’s] fraud was a betrayal of the trust placed in medical practitioners to make only legitimate claims on the Medicare system.
“It was a betrayal of the trust patients place in doctors not to abuse the personal information they provide.”
The Tribunal decided that though there may be little risk of repetition of the conduct, it was appropriate to emphasise the seriousness of the conduct of the medical practitioner.
He was reprimanded and disqualified from applying for registration until October 2024, i.e. six years from the date of the order.
In his statement, the medical practitioner stated that he wished to return to practice.
However the Tribunal points out that even when 2024 rolls around, he may still not be accepted for registration.
“We emphasise that our orders do not mean that [the doctor] will be re-registered in six years’ time, nor do they mean that it is our view now that he will be suitable for registration then,” the Tribunal highlighted.
“It is not our role to anticipate what might happen in the future or to seek to direct the Board as to what decision it might make if and when [the doctor] applies to the Board.”