Aged care demands apology over electronic claims breakdown

The two peak organisations for aged care have separately called for an apology and for financial restitution from the Department of Social Services (DSS) and the Department of Human Services (DHS) over breakdowns in electronic claiming systems over the last two years, which they say has taken them back to last century.

Leading Age Services Australia (LASA), which represents the for-profit sector, last week welcomed the launch of a new electronic claiming system for home care providers after what it says has been two years of inconvenience through repeated failures that have left the industry without properly functioning claims systems.

LASA has called for an apology from the minister for human services, Marise Payne, acknowledging the cost and inconvenience it has caused providers and clients.

LASA CEO Patrick Reid said system failures of a similar scale would not be tolerated in any other industry.

“For two years providers have absorbed the cost, time and inconvenience of operating without a functioning claims system,” Mr Reid said in a statement.

“The impact of this should not be ignored or under-estimated, and the absence of an apology from the minister to both providers and their clients is further proof that aged care does not rank highly in this government’s priorities.”

However, Aged and Community Services Australia (ACSA) has gone further, asking for a meeting with Senator Payne and DHS/Medicare to discuss compensation for lost interest on outstanding amounts and additional staff time, and debt recovery for outstanding amounts.

ACSA, which represents the not-for-profit aged and community care sectors, has written a letter to Senator Payne detailing a litany of problems reported to it by members, including inaccurate amounts on statements, multiple data entry errors, adjustments to subsidies that deduct large amounts, overpayments of subsidies, and an inability to get information or follow-up in a timely manner.

ACSA says it has sent in excess of 500 emails on behalf of members to senior people in DHS for problem resolution and has also raised these issues with DSS and Aged Care Minister Mitch Fifield’s office on several occasions over the past 18 months.

Some members are owed up to $3 million and some money still owing dates back to the 2013-14 financial year, ACSA CEO John Kelly writes in the letter.

“We estimate that about 30% of members have indicated they are having cash flow problems due to issues with the Medicare payments system,” Professor Kelly writes.

“As you can appreciate the impact of such cash flow problems will have a broader impact on the communities that providers operate in. Providers have also reported a significant increase in their staff time is being spent engaging with Medicare to resolve these issues.

“Additionally ACSA members report that they are now having issues with reconciliation which is increasing the stress levels of administration staff.”

Some of the reported problems include:

  • Long turnaround times for claims and statements that are very difficult to reconcile, with adjustments going back nine years
  • Centrelink and Medicare – both of which come under the DHS umbrella – do not seem to be talking to each other when it comes to matters such as means testing; for example, Centrelink will confirm a resident's asset assessment has been processed whereas Medicare says ‘means not disclosed’
  • No records of conversations so complaints have to be repeated to a new person
  • No response to emails for up to four weeks
  • In one example, an aged care provider said a monthly payment statement comprised 243 pages when it was normally 15 pages, which took around eight hours to reconcile; the provider is still owed $35,000 from that month
  • Even when adjustments are made following reconciliation, quite often the adjustment will be incorrect and will need to be further reconciled in the following months
  • “Particularly last financial year we have received payment statements that do not add up correctly and have advance amounts that are different to what we actually received,” one provider said
  • Another provider complained that there were two large negative adjustments – of $89,000 and $38,000 – but DHS could not tell them what these adjustments were for
  • In another case, DHS wrote to the provider saying it was recouping $200,000 from overpaid subsidies but with little information on how that amount was arrived at, and the provider's own audit showing it was at least $50,000 too high.

As one provider wrote, “This process is very expensive for providers, needing to continually go back again over accounts and payment statements now many years old – all of this additional work has been caused by [DHS's] mistakes – yet there has been no compensating for the cost to providers.”

In addition to meeting with Senator Payne and her department to discuss restitution, ACSA said it will also be advising members to pursue the assistance of the Commonwealth Ombudsman if the formal complaint and issues are not dealt with in a timely satisfactory manner by DHS.

LASA's Mr Reid said that while both DHS and DSS had worked in good faith to remedy some of the issues that have arisen with electronic claiming, work is not yet complete on other system problems that are affecting aged care providers and clients.

“This is just one of several systems issues that need to be addressed, which concerns LASA and does not instil confidence in our members, who rely on effective systems to deliver the best possible service to older Australians,” Mr Reid said.

“LASA members and staff from all LASA offices have worked closely with the departments to identify and rectify problems with their systems, and will continue to do so as it’s important for taxpayers and older Australians that we get this right.”

DHS has launched a new system called Aged Care Online Services, which is now open to all providers of home care services to claim online.

However, residential aged care provides and those that provide both home and residential aged care still need to use the older Aged Care Online Claiming system.

Posted in Aged Care

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