Medicare Billing Behaviour


Margaret is often asked why she speaks out about bad Medicare billing behaviour, here is what she has to say.

Having worked for many years at the interface of patients, payers and providers, it has become obvious that no one is happy about or trustful of our healthcare funding arrangements.

We consequently need to restore that trust and confidence, and this starts with transparency. Keeping silent about issues does not restore trust. Denying the existence of problems breeds uncertainty and patients deserve better than ambiguity. Trust will be earned when the data is in full view and shows either a clean bill of health or shows that the problems  have been addressed. So, sharing the data is the first step in achieving this.

We all know it is broken (although the extent would surprise anyone) and the attitude cannot continue to be ‘if it is broken, don’t fix it’. Because as any medical practitioner knows, you cannot begin to heal something until you identify the cause of the problem.

‘Fraud, waste, abuse and errors’ (FAWE), is the terminology used worldwide to describe the range of bad billing behaviours found in health systems. It is a common problem that every health system struggles with. The impact of this misuse is that it harms patients by rewarding poor patient care decisions, and it also harms an already burdened health system. The antidote to this is transparency – in fact, to be pro-healthcare is to be pro-transparency.

Speaking out against Medicare misuse is not a comfortable position for me to take, and highlighting fraud, waste, abuse and errors does come at a cost. I do it because I am on the side of the health system and want to see universal health coverage protected for both patients and doctors. In a Medicare system that has no checks, balances or controls, we need to have a mature conversation around healthcare payment integrity, so that this bad behaviour is no longer allowed to flourish.

Dr Margaret Faux (PhD) – Founder & Chief Executive Officer
Synapse Medical Services


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