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Comcare targets benefit rorters

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Photo: Michel O'Sullivan

The public service workplace insurer has moved to crack down on profiteering from its generous pharmaceutical benefits and on workers' compensation claims being used to fund drug habits.

Comcare has overhauled its medications policies to regulate the supply of ''drugs of dependence'' and to stop pharmacists overcharging for taxpayer-funded drugs given to injured employees.

The new policy, which comes into effect on June 1, puts pharmacists on notice that Comcare will only pay for drugs that have been medically subscribed and used to treat ''compensable injuries''.

The policy, sent out to all pharmacists nationwide who have billed Comcare in the past 12 months, also warns that the agency will not pay for drugs supplied to individuals other than the injured worker, or for medicines taken without ''clinical justification''.

The insurer has also issued a new pricing schedule for drugs, aimed at putting an end to taxpayers paying ''whatever price the pharmacist has charged'', and warns chemists not to try to charge dispensing fees for selling over-the-counter medication.

Comcare, which covers 218,000 public servants and 167,000 private sector workers, recorded a $564 million loss in 2011-12 and faces an ongoing liability of $2.6 billion for outstanding claims.

''Medical and rehabilitation'' costs, including medications, grew by 18 per cent in 2011-12 to $120 million and the scheme has promised more policies to ensure it only pays for ''clinically justified treatment''.

A recent review by Melbourne barrister Peter Hanks has recommended 147 changes to rewrite Comcare's legislative framework in a bid to rein in the costs of the insurance scheme, including stricter rules on subsidised drugs and ''doctor shopping''.

Comcare pays for the ''reasonable cost of medications'' prescribed by a doctor for a ''compensable condition'' and claims for medical costs can span decades and continue to be paid well beyond the worker's retirement age.

The new policy caps the amount pharmacists can bill the scheme when dispensing drugs that are not covered by the Pharmaceutical Benefits Scheme, known as ''privately prescribed'' medications.

''Rather than paying whatever price the pharmacist has charged, Comcare will pay a maximum 25 per cent mark up on the wholesale price plus a dispensing fee,'' a Comcare spokesman told Fairfax. ''The policy ensures that Comcare pays an appropriate price for

private script medications and over-the-counter products which will be consistently applied across the scheme in a national context.

''Again, this is consistent with the Hanks recommendation to apply legislative instruments outlining prices for medical services within the scheme.''

Comcare has also introduced guidelines around the prescription and dispensing of ''Schedule 8'' medications including controversial drugs like oxycodone, stipulating that they must be dispensed through the PBS.

''Safe prescription of these medications is an important worker safety issue within our scheme,'' the spokesman said.

''It is important to note this was also highlighted within the Hanks review.

''Mr Hanks even went further in including a recommendation that workers nominate a treating practitioner when receiving Schedule 8 medications to ensure appropriate control and management.''

6 comments

  • What utter garbage! In not one of these articles has Comcare accepted any responsibility whatsoever for its role in the massive blow out of its insurance scheme, instead preferring to demonise federal employees by suggesting they are lazy and faking injury claims. Comcare employees are Federal employees are they not?

    What has come done to actually improve the safety of federal workplaces, particularly in relation to psychosocial injuries which account for a significant proportion of the expenses incurred by Comcare.

    How many unsafe workplaces has Comcare prosecuted in the past decade? How many complaints of unsafe workplaces in relation to psychosocial injuries have been properly investigated?

    Comcare issued an improvement notice to the Commonwealth Scientific and Industrial Research Organisation last year but has it actually ensured compliance with that notice and if so what metrics have been used in the review of said compliance? Those who work in the organisation will tell you that bullying is as rife as every within the organisation even after issuing of the improvement notice.

    What action has Comcare taken in pursuing allegations of the CSIRO which HAVE been brought to its attention.

    Comcare would be far more effective in reducing its deficit if it were to properly undertake its regulatory obligations and investigating and prosecuting unsafe workplace practices rather than attacking those who are victims of its deficient regulatory practices.

    Commenter
    Injured Worker
    Location
    Queensland
    Date and time
    April 18, 2013, 9:10AM
    • First of all, the article points out that Comcare doesn't in fact only cover "Federal employees". It covers 167,000 private sector employees. Secondly, you accuse ComCare of taking no responsibility for the cost blowout. If anything, that matches the behaviour of a lot of the claimants that I have known. They take no responsibility for their own health & sickness, and they have no insight into the way in which their own basic Victim Mentality leads them into the situations that they find themselves in and they way it keeps them there. It's the same overall syndrome that gives us a Sickness Industry rather than a Health System. I would hate to be a medical professional and to have to deal with this mentality.

      Commenter
      Mike Micanopy
      Location
      Gnilabura
      Date and time
      April 18, 2013, 12:36PM
    • "Sickness Industry" is right and I may as well say that everything gets rorted, something involving drugs AND money is bound to sink like a stone to the lowest possible level. Socialism never seems to work, best keep it to the absolute minimum.

      Commenter
      bg
      Date and time
      April 19, 2013, 7:15AM
  • @injured worker. give me a break. its people like you that are the cause of a blow out. compare the psych injuries in the private sector before opening your mouth as they are not covered by the best compensation scheme in the country which gives the injured worker 45 weeks of full pay while injured.
    it is far to easy to point the finger in the APS and say you have been bullied and its becoming a joke.
    Comcare should come down hard on the injured workers who choose to prolong claims once liability has been afirmed and choose to use the system to prolong the costs to the workplace the tax payer and the poor people who have to listen to this sort of bs.

    Comcare dont even act as a insurer and claims are accpeted easier then they are in the private schemes so you tell me the difference.

    Commenter
    yes
    Date and time
    April 18, 2013, 11:21AM
    • Comcare's "accounting loss" of $564 million in 2011-12 was created by an actuary providing a new estimate of potential future liability on potential future claims. The loss has not been realised and if the estimate is revised down at any time in the future, this "loss" will vanish completely.

      See "Comcare’s actuary has estimated that the actuarial liability for the premium compensation claims as at 30 June 2012 is $2,174.9m (2011: $1,517.3m)" at url https://www.comcare.gov.au/annual_report_2011-12/financial_reports/comcare_notes/disclosure_of_funding_for_comcare

      Commenter
      Some Balance
      Location
      Canberra
      Date and time
      April 18, 2013, 10:16PM
      • It is not quite accurate to say "A recent review by Melbourne barrister Peter Hanks has recommended 147 changes to rewrite Comcare's legislative framework in a bid to rein in the costs of the insurance scheme"

        The Terms of Reference for the review include:

        "The impact of workplace harm on workers and their families is significant..."
        "The Government believes that the Comcare scheme should be exemplary..."
        "It is the Government’s intention that the review will not consider any reduction in existing benefits afforded to workers covered by the Comcare scheme."

        Commenter
        Some Balance
        Location
        Canberra
        Date and time
        April 18, 2013, 10:26PM
        Comments are now closed
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