Auditor general finds Medicare payments to doctors need better auditing, monitoring, and public reporting04 December 2012
FREDERICTON (GNB) – In her report released today, auditor general Kim MacPherson looked at the Department of Health's internal audit process for payments to doctors. MacPherson recognized the essential role New Brunswick doctors play in the delivery of health care. She emphasized her work was not intended to assess the quality of doctors' services.
She found the audit process had several significant weaknesses.
Medicare represents one of the province's highest-cost programs. During fiscal 2011, about 1,900 doctors were paid more than $500 million, however, only half of the total dollars paid out to doctors is subject to audit.
While the department has the authority to audit all types of Medicare payments, MacPherson found that only a portion of fee-for-service payments are audited each year. Salary and hourly payments to doctors are not audited. MacPherson provided tables showing various analyses of Medicare payments to doctors, and identifying some unusually high amounts. In 2011, 16 doctors were each paid more than $1 million.
“When you consider the complexity of the system, the fact that services are not confirmed by patients and the fact that there is no penalty for overcharging, there is an inherent risk of overpayment,” said MacPherson.
She recommended that the department develop and implement proper monitoring procedures for all Medicare payments.
Audit recoveries of overpayments to doctors are low, averaging less than $73,000 per year. By strengthening the audit function and addressing the weaknesses noted, it will not only ensure compliance with legislation, agreements and policies, but will also serve as a deterrent to inappropriate billings.
MacPherson also recommended improved public reporting of doctor remuneration. This would follow the same public reporting practice of virtually all other employees and suppliers to government.
“Publicly reporting only some of the Medicare payments to some of the doctors is incomplete and misleading,” she said. “In order for the department to demonstrate proper accountability for more than half of a billion dollars in annual spending, the distribution of this spending should be publicly reported and subject to public scrutiny.”
MacPherson believes there is an opportunity for the department to increase audit recoveries and achieve substantial program savings through expanding the audit unit's coverage to include all Medicare payments, using a risk-based audit approach, strengthening monitoring and enforcement, and addressing other issues identified by her review.
Today's report contains two volumes; Volume I focuses on matters arising from the annual financial audit of the province and Crown agencies. Volume II reports the results of Value for Money projects completed during 2012. Both volumes are available on the Office of the Auditor General website.
● Office of the Auditor General