About Medichecker
Hi, my name is Dr. Margaret Faux. I am the founder and CEO of a MedTech company called Synapse Medical. I have worked in health systems around the world for 40 years and have administered Australian Medicare bills since Medicare began.
I’m a nurse-turned-lawyer specialised in Medicare and health insurance law, and I have a PhD on Medicare Claiming and Compliance.
In October 2022, I was featured in a series of media stories by ABC 7.30, The SMH and The Age, in which I estimated systemwide leakage from Medicare caused by fraud, overservicing and errors was up to 30%. This estimate was based on evidence and experience and is consistent with international estimates.
When the stories broke, all and sundry entered the fray. There were the usual vested interests and powerful medical lobby, but also newcomers like Dr Eddie Cliff and Dr Tori Berquist, both Fulbright Scholars at Harvard, who co-authored a piece that did the rounds. Suddenly everyone had something to say about Medicare fraud.
Coincidentally, one of the world’s leading experts in healthcare fraud is Professor Malcolm Sparrow from the John F. Kennedy School of Government at Harvard. In 2004 he visited Australia and while here, appeared on ABC Four Corners where he said:
“Australian culture is not the same as American culture but the nature of the fraud risks is tied directly to the structure of the payment system. And you and your Medicare program and your other fee-for-service programs have exactly the same structure as the U.S traditional fee-for-service systems. So you face the same risks, whether you like it or not.”
He was right. I now have a decade of experience administering U.S medical bills and can confirm that the risks and frauds I see in both systems are the same, but the U.S system manages them better than we do, so, whatever the U.S figure is, ours is higher. You can watch the COST OF MEDICAL FRAUD video in which Professor Sparrow estimates the U.S figure could also be 30%.
The truth is that nobody has ever conducted a statistically valid measurement of the rates of fraud, abuse, waste, error, and overpayments within the Australian Medicare program. Without that, everyone is entitled to make their own best guesses, based on their knowledge of the systems in place and their vulnerabilities. I have four decades of experience and a PhD in this field and am entitled to my own estimates. Deloitte is entitled to theirs , based on what they have described as “desk-based analysis” (which is never sufficient to uncover fraud). Cliff and Berquist are entitled to their own guesses based on their own lack of experience in fraud control and no research at all of their own.
It is time for us to move beyond the battle of competing but inevitably rough estimates. Instead, we need to measure the scale of the problem in a reliable and systematic way. We know how to do that—using rigorous audits of random samples that include conversations with patients—but there has never been the political will to conduct such measurements and reveal the true scope of the issue. Only when unambiguous facts about loss rates are put on the table can the debate progress beyond the ultimately pointless “who’s estimate is better” and of course the persistent attempts by vested interests to pretend “this is not really serious”. We need urgently to move on to “what to do about it”. Because when no-one knows how much is being lost, no-one knows how much to spend on tackling the problem, nor how aggressive an approach to take in protecting public funds.
The consumer voice has always been missing from this critically important national debate, and without it, we will never be able to accurately measure the size of this problem. The purpose of Medichecker is to plug this gap.