Safeguarding the integrity of veteran support systems
Most health providers do the right thing and offer invaluable support to veterans and families.
However, there are some who look to take advantage of the system for their own personal gain. DVA is seeing increased reports of behaviour by providers that is self-serving and not in the best interests of the veteran community – and some that could be fraudulent.
Some of the concerning behaviours which DVA has identified include: submitting invoices that do not match services provided to clients invoicing DVA at exorbitant rates (without clear clinical justification) delivering low value and clinically unnecessary care claiming for medical investigations or material that DVA has not requested or is not needed.
DVA is aware of some cases where, veterans have been deceived into undergoing unnecessary medical examinations, resulting in significant risks to their health, purely so the provider can charge the Department.
DVA has an obligation to ensure taxpayers funds are used responsibly and will not tolerate those who look to take advantage of Australia’s veteran support systems for personal gain.
We work cooperatively with more than 20 other government agencies – including the Australian Criminal Intelligence Commission, the Australian Federal Police, and the Australian Tax Office – in a Fraud Fusion Taskforce to find and stop acts of fraud across government payment programs.
DVA has identified non-compliant billing behaviour by some medical providers. Separately, DVA has determined it will no longer pay for services from some providers due to serious non-compliance. We have also received information that a small number of advocates and/or providers have supplied compensation medical reports that appear to have been allegedly deliberately altered in an attempt to achieve a higher monetary payment, or are otherwise out of keeping with normal billing practices.
Clients affected by these investigations are being supported by the Department, including through direct contact and referral to alternative providers.
DVA has recently reviewed and updated official documents and guidelines that outline health provider responsibilities, including how they should act and make decisions when treating our clients. This includes reminding providers of the requirement to disclose any relationships and/or commercial interests to veterans when they provide referrals to other providers.
Where a provider is found to have engaged in inappropriate practices, DVA can take a variety of actions, including corrective education about policies and procedures, referral to the regulator or other relevant professional bodies, declining to fund future services, debt recovery, or referral to the Australian Federal Police.
We’ve put these new systems in place to prevent health providers from exploiting the veteran support system by engaging in illegal, inappropriate and unethical behaviour. We’re calling out business practices and advocacy services that put profits ahead of veteran care.
DVA wants veterans to be aware of these risks and feel empowered to ask questions. If you are unsure about why a referral is being made or suspect that something “feels off”, you have the right to speak up. By doing so, you can help make it easier for veterans and families to access fair, transparent and accountable care and compensation that supports their wellbeing.
We encourage anyone with concerns about the conduct of a provider in relation to DVA services to report it confidentially to fraud.tipoff@dva.gov.au.