In this edition: the Queensland Health Transparency Bill 2019, Medibank, Victoria’s Public Health and Wellbeing Regulations 2009, and pharmacy suspension over codeine prescriptions.

The latest insights from our Health Law team:

Who is taking care of your parents and grandparents

Medibank accused of making customers upgrade, wait for surgery that should have been covered

Health Victoria Comments: Public Health and Wellbeing Rules

Pharmacist suspended over codeine prescriptions

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Who is taking care of your parents and grandparents

On 4 September 2019, the Health Transparency Bill 2019 (the Bill) was introduced to the Queensland Parliament proposing to “improve the transparency of the quality and safety of health services provided in Queensland” and “to help people make better-informed decisions about their health care” (section 3 of the Bill). Minister for Health and Ambulance Services, Steven Miles, says:

“When it is enacted, this Bill will help open up private and public facilities to similar levels of scrutiny, which will help improve the care provided to older Queenslanders…”

The Bill empowers the chief executive to request and collect certain information from public and private health care facilities and public and private residential aged care facilities (Facilities), including:

  1. General information, such as the Facility’s contact information, an outline of services provided by the Facility and an outline of services that may be available near the Facility, like a carpark.
  2. Quality and safety information, such as details of the Facility’s accreditation and performance against the National Safety and Quality Health Service Standards, time frames for access to care, the number of patients admitted by the Facility and the effectiveness of the health care provided by the Facility to the person.
  3. Residential care information, such as an outline of the personal care and nursing care provided at the Facility and details of the staffing.

In its media statement, the Queensland Government has advised that the information collected may be published by the chief executive on a new interactive website. This will enable the public to compare Facilities.

The media statement also advises that the Bill requires “Queensland Health’s residential aged care facilities to have a minimum nurse skill mix of 50 per cent and for 30 per cent of the total care staff to be registered nurses. These residential aged care facilities must also provide a minimum average of 3.65 hours of nursing and personal care to residents daily”.

To read the Bill, click here.

Medibank accused of making customers upgrade, wait for surgery that should have been covered

The Australian Competition and Consumer Commission (ACCC) has initiated proceedings in the Federal Court against Medibank Private for alleged breaches of the Australian Consumer Law.

The ACCC alleges that Medibank falsely represented that some of its customers were not entitled to health insurance cover for certain joint investigations and reconstructions, when in fact the customers’ policies did cover joint investigations and reconstructions. The ACCC further alleges that the health insurer wrongfully accepted payment from its customers for cover that it did not supply.

The allegations concern the “Lite” and “Boost” policies sold under Medibank’s low-cost ‘ahm’ brand name. ACCC Chair Rod Sims said “we will allege that Medibank incorrectly rejected claims or eligibility enquiries from over 800 member for benefits that they were entitled to and were paying for.” The ACCC estimates that “about 60 members needlessly upgraded their policies so they could access the joint investigation and reconstruction procedures they were already entitled to under their existing, cheaper insurance policies.”

Medibank self-reported the conduct to the ACCC and has begun compensating affected members. In a statement the health insurer blamed the error on an “internal process failure.” It said that Medicare Benefits Schedule item codes associated with joint and reconstruction surgery were not entered into the system for the “Boost” and “Lite” Policies.

Mr Sims said “Medibank’s alleged misrepresentations had serious consequences for members requiring procedures including spinal surgery, pelvic surgery, hip surgery and knee reconstructions, which often cost thousands of dollars.”

“Some members were forced to delay surgery due to high out-of-pocket costs for these procedures and to seek alternative remedies to manage pain, when they were in fact entitled to insurance cover.”

The ACCC seeks penalties, consumer redress, declarations, injunctions, publication orders and the implementation of a compliance program and costs.

You can read the ACCC’s media release here.

Health Victoria Comments: Public Health and Wellbeing Rules

Victoria’s Public Health and Wellbeing Regulations 2009 (Regulations) expire in December this year and need to be reviewed. The Regulations were made under the Public Health and Wellbeing Act 2008 (Act), which provides a legislative framework that promotes and protects public health and wellbeing in Victoria.

The aim of the Regulations is to provide a framework for businesses, councils and individuals in the practical application of the Act. As the Regulations will need to be remade, the Victorian government has taken this opportunity to strengthen and modernise Victoria’s public health approach.

The government has developed a regulatory impact statement, which provides an assessment on how the current Regulations and any proposed changes, will impact businesses, the community and the environment. According to a statement by the Department of Health and Human Services (Department), some of the key proposed options include:

  1. strengthening and clarifying requirements relating to cooling tower systems;
  2. adopting a national framework for minimum training and licensing of pest control operators; and
  3. updating infectious disease exclusion requirements in child care centres and primary schools.

The Department is inviting Victorians to comment on the proposed new regulations until Monday 30 September 2019.

Access the regulatory impact statement and more information on how to comment here.

Read the Department’s media release here.

Pharmacist suspended over codeine prescriptions

Pharmacist Huyen Tran was convicted and fined $100,000 and ordered to pay $10,708 in legal costs following pleading guilty plea to ten charges relating generally to the supply of codeine-containing analgesics under the Drugs, Poisons and Controlled Substances Act 1981 (Vic) (Act).

Ms Tran’s pharmacy was investigated after the Department of Health identified a patient who had obtained the state’s highest dose of codeine-containing medicines from the pharmacy between June and October 2018.

Ms Tran pleaded guilty to:

  • having filled fraudulent prescriptions when she had reason to believe that the scripts were fraudulent (on 281 occasions);
  • filling prescriptions in excess of instructions (9 occasions); and
  • failing to notify the Department of Health and Human Services that she was requested to supply codeine-containing analgesics to a patient in higher quantities than instructed (on 167 occasions).

Between 2015 and 2018, Ms Tran’s pharmacy dispensed to one patient, on average, about 40 tablets per day in 2015, escalating to about 57 tablets per day during 2018.

Ms Tran’s registration has been suspended since March 2019.