Auckland GP charged over receiving $420,000 for ineligible backpackers

This makes Australian and British backpackers “eligible, but not necessarily entitled to funded healthcare”, if they do not meet requirements

A GP has been charged with professional misconduct over claiming capitation for Australian and British backpackers at her Auckland practice.

The hearing on charges relating to incidents between 2003 and 2011 began today in Auckland before the Health Practitioners Disciplinary Tribunal but the GP made no appearance.

The doctor and all the patients involved have been granted name suppression by the tribunal.

The professional conduct committee (PCC) says the doctor’s practice received more than $420,000 in ineligible capitation funding by submitting age/sex registers of 2618 patients to ProCare Health PHO who did not meet various eligibility criteria.

Ministry of Health audit and compliance investigator Christopher Unsted was brought to the tribunal as a witness today by the PCC.

As one of the lead investigators involved in the dispute, Mr Unsted laid out for the tribunal what overseas patients are entitled to and eligible for.

He explained to be entitled to subsidised healthcare, patients who are not citizens or residents of New Zealand must fit a range of requirements according to their country of origin.

For example, travellers from Australia or the UK are eligible for funding if they require “immediately necessary” healthcare, because New Zealand has a reciprocal agreement with Australia and the UK.

This makes Australian and British backpackers “eligible, but not necessarily entitled to funded healthcare”, if they do not meet requirements, says Mr Unsted.

Travellers from outside these areas are automatically ineligible.

The tribunal today heard examples of backpackers who presented to the doctor’s practice requiring non-essential healthcare such as travel-related vaccinations. Mr Unsted says these patients are not entitled to funding.

There were 194 Australian patients within this category and 1221 British patients.

Additionally, 511 patients from the UK did meet the requirements of “immediately necessary” healthcare, however, were enrolled to receive ongoing care, which is outside of funding regulations. A total of $83,191 of funding was received from ProCare to fund these patients, many of whom spent a matter of weeks or months in New Zealand but were funded for up to several years.

The doctor also submitted 194 patients who did not sign the enrolment form. Funding of $23,024 was received for these patients.

The PCC, represented by lawyers Hayden Wilson and Amelia Retter, laid the charge against the doctor on 13 August 2019.

In a written and signed letter to the tribunal, the doctor says she does not admit the charge. She says she always acted in good faith for her Australian and UK patients.

She indicated in the letter that the ministry guidelines, and particularly the change in legislation bringing in capitation in 2003, were unclear.

She believes she provided ProCare with all the necessary details about the patients’ country of residence and travel dates, and therefore ProCare or the ministry should have identified potential ineligibility of patients.

“I disclosed this information; this is not the behaviour of a fraudulent person.”

The doctor’s letter also said her email correspondence with the ministry went repeatedly unanswered.

The three-day hearing is due to finish tomorrow.

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