An explosive News Corp investigation has revealed a major public hospital rort.
An explosive News Corp investigation has revealed a major public hospital rort.

Desperate public hospitals bill dead people

Exclusive: Cash strapped public hospitals are pursuing people beyond the grave, demanding grieving relatives bill their deceased loved one's private health fund for their treatment.

An explosive News Corp investigation has found women who suffer miscarriages, burns victims and people who have heart attacks are facing massive out of pocket costs after they bow to public hospital pressure to bill their care to their health fund.

Public hospitals are earning $1.6 billion a year by charging health funds for treatments patients are entitled to for free under Medicare.

The practice is adding almost $100 a year to the average premium.

Sydney’s Concord Hospital is under fire for charging private health funds for treatments patients are entitled to for free under Medicare. Picture: Jonathan Ng
Sydney’s Concord Hospital is under fire for charging private health funds for treatments patients are entitled to for free under Medicare. Picture: Jonathan Ng

Last year Bupa members alone paid more than $3.5 million in out of pocket costs in New South Wales public hospitals, in some instances up to $1500 each.

"In many cases the out of pockets were being charged to patients that presented as acute or emergency patients in the public system and we strongly believe it is inappropriate to charge an out of pocket to Australians in that situation," Bupa Managing Director Dwayne Crombie said.

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Today News Corp can reveal the extent of the cash grab and how public hospitals are putting revenue ahead of patient care.

Triage in hospital emergency departments now starts with an administrative officer trying to get you to bill your health fund not a nurse interested in the state of your health.

A job advertisement for a hospital administrative staffer overtly states their job is "maximising all sources of revenue" and to "implement strategies to improve the identification of compensable patients and the level of private health insurance use."

Some hospitals are pursuing patients even after they have been discharged writing them letters urging them to allow the hospital to bill their health fund.

Former Concord Hospital staff Frank Collins lifted the lid on the public hospital rort. Picture: Dylan Robinson
Former Concord Hospital staff Frank Collins lifted the lid on the public hospital rort. Picture: Dylan Robinson

Whistleblower Frank Collins, who worked at Sydney's Concord Hospital until earlier this year, resigned after he was threatened with the sack because he would not pursue patients including the relatives of dead people to get them to bill their health fund.

"About 4-5 years ago we got a directive that from now on deceased patients would be treated as inpatients and if they were in a health fund we had to get their family to sign so the health fund covered their care," he said.

"I see it as immoral and illegal and I'm a member of a health fund and I know it's why premiums are going up."

News Corp can also reveal:

 

- Concord Hospital staff must meet a quota of getting every privately insured patient to agree to have their health fund billed for their care and are disciplined and threatened with the sack if they don't.

- Sources have told News Corp one woman actually gave birth in the hospital toilet one night in 2017 because it was taking so long to do her ED paperwork.

- Reinforcing the policy that puts money ahead of patient care one manager of patient registration at Concord Hospital had a tag line on her emails that said: "Revenue is everybody's business".

- If the patient is unconscious staff have to get their family members to get the health fund to cover their treatment.

 

email from Concord hospital admin officer to staff members
email from Concord hospital admin officer to staff members "Revenue is everybody's business"

 

Mr Collins recalled a story of a patient who agreed to have his health fund pay for his public hospital treatment then came back to complain that the promise he could choose his own doctor for the surgery had not been honoured.

 

 

When asked how he would know because he would have been unconscious he explained that the procedure took place under a local anaesthetic and he could tell it wasn't the doctor he had requested.

He also complained he was left with a lot of out of pocket expenses not covered by his health fund.

"They lie to patients and say there will be no bills and two weeks later the patient has got a fistful of bills," he said.

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Private Healthcare Australia chief Dr Rachel David said "obviously Concord Hospital has no interest in treating public patients".

"I think NSW Health should be asked do they want to designate Concord Hospital as a private hospital and health funds will enter a proper contract with them," she said.

"If NSW Health does not want to run a public hospital system but instead wants to run a private system why not be open about it."

Bupa managing director Dwayne Crombie said in many cases out of pockets were being charged to patients that presented as acute or emergency patients. Picture: Supplied.
Bupa managing director Dwayne Crombie said in many cases out of pockets were being charged to patients that presented as acute or emergency patients. Picture: Supplied.

A spokesman from Concord Hospital said in accordance with the National Health Reform Agreement 2012 "patients may choose to elect to use their private health insurance in a public hospital".

"Any discussions that are undertaken in that regard may be initiated by the patient or hospital to clarify those entitlements. This allows patients to access their doctor of choice and accommodation in a single room, if available," the spokesman said.

"Private patient revenue is retained by local hospitals and is used for the benefit of patients and their families"

A spokesman for NSW Health Minister Brad Hazzard said only a small per centage of health fund payouts went to public hospitals.

"The amount that private health insurers pay to state and territory public hospitals is a fraction of the cost of providing single rooms to patients," the spokesman said.

 

 

WHAT TO DO IF A PUBLIC HOSPITAL ASKS TO BILL YOUR HEALTH FUND

1. Say no.

2. Explain that you pay your Medicare levy and are entitled to free care in a public hospital.

3. Tell staff if you bill your health fund for your public hospital treatment your private health fund premiums will go up. They are already $100 a year higher because of public hospitals are charging private funds for public hospital care.

 

IF YOU DECIDE TO BILL YOUR HEALTH FUND

1. Ask whether you will be guaranteed doctor of choice or a private room if you bill your fund.

2. Seek a guarantee that if you bill your fund you will not have to pay any out of pocket expenses or medical gap fees.

3. Ask for a cooling-off period to check whether your health fund policy actually covers the type of care you will receive.

 

Have you been affected? Email Sue Dunlevy at sue.dunlevy@news.com.au