One Nation leader Pauline Hanson's plan to combat Medicare fraud by placing photos on cards would cost half a billion dollars and have limited effect, bureaucrats say.
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The senator introduced a private member's bill in February to stamp out "rorting" of the health system that she said cost taxpayers millions.
She said there was nothing to stop someone who did not qualify for free or subsidised medical assistance from borrowing a card from a friend.
"It does happen. When was the last time someone checked your ID when you used your Medicare card? It has never happened to me," Senator Hanson said.
But the Department of Human Services told a Senate committee examining the draft legislation the idea had been estimated to cost $500 million when it was scoped several years ago.
A Medicare smartcard was piloted in Tasmania in 2004, attracting significant public and media interest over privacy concerns.
Citizen uptake was minimal and the pilot was discontinued, the department said.
The 2017 Shergold review also looked at the idea and determined that while a photograph or hologram might reduce Medicare card fraud in the short term, such changes were not likely to have a lasting effect.
Fraud also appeared to be rare; 84 cases were referred to the Commonwealth Director of Public Prosecutions last financial year.
"This represents a very small proportion of the 25.6 million Medicare customers," the department said.
The Australian Medical Association said the proposal would significantly add to the red tape patients and providers already dealt with.
It pointed out patients did not need to present their Medicare card when accessing health services - their Medicare number was enough.
"This renders the photograph on the front of the card useless," the association said.
The placement of photos on Medicare cards presented another dilemma.
Up to nine people can be included on one Medicare number, and up to five names on one individual card.
"There is very little remaining space on the front of a Medicare card when five names appear, let alone for an additional five photographs," the AMA said.
"Multiple photographs with enough clarity to enable identification would be exceptionally difficult in these circumstances. There is a risk with unclear photographs that a patient may be denied access to care, were it deemed by the service provider that they did not match their photo, and could not confirm their identity another way."
Photos of children added to their parent's cards posed another problem.
"Medicare cards are valid for five years, so by the time that infant is a toddler, their appearance would be completely different to the photograph on the card," the AMA said.
"For them to be reliably identified, replacement certified photographs would need to be provided as the child's appearance changes. This adds another administrative burden on busy parents and additional costs to the provider of the photograph."
The department said the number of Medicare cards would need to increase from 14.5 million to 25.6 million to accommodate individual cards with photos.
"The department believes there are more effective and efficient ways to ensure the integrity of Medicare into the future," officials said.
The Senate committee is due to report back next week.
