Purpose of the bill
1.1
The Human Services Amendment (Photographic Identification and Fraud Prevention) Bill 2019 (bill) seeks to amend the Human Services (Medicare) Act 1973 (Medicare Act) to require that a Medicare card include photographic identification of the person to whom it is issued; and to impose a penalty of 2 years' imprisonment and/or 50 penalty units for fraudulent use of a Medicare card.
Background
Eligibility for Medicare
1.2
Medicare is Australia's universal health care system; which provides free or subsidised health care services for eligible individuals.
1.3
Currently, an individual is eligible to enrol in Medicare and receive a Medicare card if they are living in Australia and are one of the following:
an Australian permanent resident;
applying for permanent residency; or
covered by a ministerial order.
1.4
Some citizens or permanent residents of Norfolk Island, Cocos (Keeling) Islands, Christmas Island and Lord Howe Island are also eligible.
1.5
Further, Australia has reciprocal arrangements in place to provide healthcare for visitors from other countries including Belgium, Finland, Italy, Malta, the Netherlands, Norway, Ireland, Slovenia, Sweden and the United Kingdom.
Use of Medicare cards
1.6
Currently, a Medicare card includes the name of the person to whom the card has been issued as well as a Medicare number and individual reference number (IRN).
1.7
A Medicare card may also list the details of the main cardholder's partner and/or children. Each individual listed on the card has a unique IRN.
1.8
A Medicare card (or number) is used to access a range of medical services at a lower cost, as well as for care in a public hospital, and a reduced cost for pharmacy medicines covered by the Pharmaceutical Benefits Scheme. Medicare cards can also be presented in digital form to gain access to health services.
1.9
An individual is not legally required to produce their Medicare card in order to gain access to health services—only the Medicare number is required. If an individual does not have their Medicare card number with them, health providers can confirm a patient's Medicare number using an online system called Health Professional Online Services (HPOS).
Review of access to Medicare card numbers
1.10
In July 2017, following media reports of an alleged breach related to several Medicare card numbers, the government announced an Independent Review of Health Providers' Access to Medicare Card Numbers (Shergold review). The review considered a broad spectrum of issues related to Medicare card numbers including current vulnerabilities in the Medicare system, and how these could be addressed so that Medicare card information could be better protected.
1.11
In particular, the Shergold review considered the potential for fraudulent use of a Medicare card, noting that 'individuals who are not eligible for Medicare may have an incentive to fraudulently obtain a Medicare card number' as this could enable them to 'access subsidised health services, lower cost prescriptions or free care as a public patient in a public hospital'.
1.12
The Shergold review looked at measures that could be introduced to assist in preventing fraudulent use of Medicare card numbers, and concluded that 'while adding a photograph or other security feature such as a hologram might have a short term beneficial impact on the illegal reproduction of Medicare cards, such changes are not likely to have a lasting effect'.
1.13
The Shergold review made 14 recommendations. In relation to the potential for fraudulent use of a Medicare card number, Recommendation 3 proposed that 'as a condition of claiming Medicare benefits on behalf of patients, health professionals should be required to take reasonable steps to confirm the identity of their patients when they are first treated'.
1.14
In its response to the Shergold review, the government supported this recommendation, stating:
The Departments of Health and Human Services will work collaboratively with health professional bodies to ensure their existing guidance and educational materials are reviewed and enhanced to address patient identification responsibilities under Medicare as well as within the context of the doctor-patient relationship.
Key provisions of the bill
1.15
The bill proposes to amend the Medicare Act in two principle ways. The first is to require that a Medicare card include photographic identification of the person to whom it is issued by inserting a new section 41A which stipulates that 'a medicare card issued to a person must include medicare card information'; and further, by creating a new definition of 'medicare card information' which specifies that this information must include a photograph of the card holder:
medicare card information means information contained on the front of a Medicare card, including the following:
the individual reference number of a person;
the medicare number of a person;
the family name, given name or names;
the medicare card holder’s photograph;
1.16
The second is to include a new section in the Medicare Act, relating to payment obtained through fraud. This would impose a penalty of 2 years' imprisonment and/or 50 penalty units for fraudulent use of another person's medicare card or for impersonating a card holder to obtain a benefit:
41BA Payment obtained through fraud etc.
A person shall not by:
means of impersonation; or
false or misleading statements; or
fraudulent use of a medicare card;
obtain a benefit or payment in respect of the supply of benefits under:
this Act; or
the Health Insurance Act 1973; or
the National Health Act 1953.
Penalty: Imprisonment for 2 years, or 50 penalty units, or both.
1.17
The bill also proposes to include established definitions of 'eligible person', 'medicare card', and 'medicare number' into the Medicare Act; and requires the Minister to be satisfied of a person's identity and eligibility for a Medicare card.
Financial implications
1.18
The explanatory memorandum (EM) does not set out the cost of implementing the measures proposed in the bill. The potential cost of the proposal is discussed in chapter 2 of this report.
Legislative scrutiny
1.19
The EM notes that the bill is compatible with the human rights and freedoms declared in the international instruments listed in section 3 of the Human Rights (Parliamentary Scrutiny) Act 2011.
1.20
The Parliamentary Joint Committee on Human Rights noted that the bill appears to engage and may limit human rights; and that further information may be requested from the proponent of the bill, should it proceed to further stages of debate.
1.21
The Senate Standing Committee for the Scrutiny of Bills did not make any comment on the bill.
Conduct of the inquiry
1.22
The bill was first introduced into the Senate on 13 February 2019 and lapsed at the end of the 45th Parliament. The bill was restored to the notice paper on
24 July 2019. Pursuant to the adoption of the Senate Standing Committee for the Selection of Bills report on 1 August 2019, the bill was referred to the Community Affairs Legislation Committee (committee) for inquiry and report by 12 September 2019.
1.23
On 9 September the Senate granted an extension to report by 16 October 2019.
Submissions
1.24
The committee wrote to relevant organisations and individuals and invited them to make a submission to the inquiry by 30 August 2019. Submissions continued to be accepted after this date.
1.25
The committee received 8 public submissions which are published on the committee's website. A list of submissions received is included at Appendix 1.
Witnesses
1.26
A public hearing for the inquiry was held in Canberra on 16 September 2019.
1.27
The committee heard evidence from medical professionals and organisations, as well as from the Department of Social Services and Services Australia (Department of Human Services). A list of witnesses is included at Appendix 2.
Acknowledgement
1.28
The committee would like to thank those individuals and organisations that made submissions and gave evidence at the public hearing.
Note on references
1.29
References to the Committee Hansard are to the proof Hansard. Page numbers may vary between the proof and official Hansard transcripts.