How crooks cashed in on Covid with massive Medicare rorts - including one doctor who ordered a staggering 21,000 Covid tests in just ONE day

Doctors and clinic operators are being accused of  'systematic fraud' after it was revealed one practitioner triggered $1.5million worth of Covid testing in just one day.

In that case the doctor requested 21,000 tests for a single day, which breached the rules that doctors must clinically assess each case individually.

At the standard $72.25 bulk-billing Covid test billing rate the doctor would have been cost Medicare $1.5 million.

Health economist Professor Stephen Duckett, who was the former Department of Health and Aged Care secretary, said it was a clear rort but was apparently signed off.

'This doctor could not have seen that number of patients and made an informed decision, whether this was a routine test, whether this was a symptomatic test, it just is not possible for that to have happened,' he said.  

The Department of Health and Aged Care received 47 tips alerting it to potential South Australian Covid testing frauds, according to Freedom of Information documents obtained by the ABC after a three-year battle for access.

Companies that were recompensed for operating state and federal government funded pop-up and drive-through testing clinics were still claiming the full cost from Medicare and double dipping, the documents show. 

Tests were also being claimed for people who had no valid referral from a doctor or nurse. 

Professor Duckett said it was clear there was 'systematic rorting on a very large scale' which had often charged Medicare instead of the state government.

Professor Duckett said testing centres should have known whether they were set up by the state government and sent the bills there rather than Medicare.

'My own view is that it looks to me deliberate,' he said.

Professor Duckett said documented co-claims for flu and RSV tests at drive-throughs should have been a red flag that potentially 'opportunistic' claiming was happened.

The pop-up and drive-through clinics were designated to be solely for testing for Covid and anything else was 'not consistent' with the rules, Professor Duckett said.

In response to testing concerns, the Department of Health wrote to nine pathologists and four pathology companies in October and November 2020 'reminding them … tests needed to be clinically relevant to be claimed through Medicare'.

Six more letters were sent to pathology companies in September 2021 telling them that asymptomatic or surveillance testing had to be claimed through the state government, not through the federal government's Medicare program.

In December 2021 seven pathology companies received such warnings but the names of the recipients have been withheld.

Professor Duckett said it seemed the letters were being largely ignored.

'These are very powerful operators, but it looks like they're not being held to account and they ought to be,' he said.

Peak body Australian Pathology chief executive Liesel Wett denied there was rorting and said testers were subject to routine compliance checks.

'To our knowledge, there has never been any significant findings of Medicare non-compliance against members of Australian Pathology during the period,' she said in a statement to the ABC.

She also said there were also multiple checks and balances in the system and said during the pandemic you did not need a referral to be tested.

'The overwhelming public health messaging from all tiers of government was to get tested if you felt you had symptoms, or felt you had been exposed, particularly given they were required to isolate till they got the results of a test. 

'It would have been absurd to refer patients back to a GP.'

The Department of Health and Aged Care spokesperson said it had 'robust' compliance programs.

While the Department said it could not detail all its 'investigations and treatments' it writing to pathology companies was the only measure it took.

'The department does not assume non-compliance from data alone. Generally, there is a need to assess additional information with the rendering health professional, testing provider or state government,' it said.

'Compliance activities undertaken at the time resulted in a significant shift toward compliant billing. Consideration of compliance in this area is ongoing.'

By January 2022 there had been approximately 27.8 million bulk-billed Covid tests at a cost of around $2.3 billion to Medicare.