GP Dr. Jane Kennedy asked me this excellent question in response to a recent national media story called “Expert estimates $8 billion a year lost to Medicare fraud and waste.” on the ABC 7:30pm report.

Her question was:

“What steps has the medical profession taken to stamp out fraud and get rid of the fraudsters within its ranks?”

Her question deserves a response due to my 30-year involvement with this issue.

Currently, the medical and healthcare professions do not appear to be as self-regulated with tacit government oversight as the legal and accounting professions.

“How can medical professionals avoid such damaging headlines?”

“Is it possible to improve the checks and balances before the media or regulators get involved?”

“How do you solve this problem as well as the perennial problem of appropriate healthcare funding?”

“Can a good long-term business case be made to improve a socially responsible and well funded high-quality health care system?”

The simple answer is yes to all of the above.

Instead of looking bottom up, start at the top and look downward

I used to work as a corporate fraud investigator. Until recently, the Medicare system allowed doctors to bill dead people.  A comprehensive healthcare accounting system is required to prove fraud or waste. 

There is no commonly agreed “clinically relevant” contextually defined healthcare information that is open and transparent. On that basis, it is impossible to prosecute a clinical fraud case, without a law (i.e. Health Insurance Act Act 1973) that poorly deals with this impediment. 

Unless it is really obvious, this is why no doctor has gone to jail. It is also why it is more softly referred to as “inappropriate practice” and not fraud. For the record  I do not support dishonesty. Quite the opposite.

Would you build and live in your family home without using an architect?

I will use this building a home analogy. Would you spend a cent on building or residing your family in a home without an architect? Contrarily, the entire local and international healthcare system is based on a collection of haphazardly combined, well-intended symptomatic solutions. There is no architect on site.

We must start over, just like an architect, and go back to the drawing board. Excellent bottom-up building strategies abound. They are stored in silos and, like bricks and window panes for a family home, they require careful direction regarding where to be placed.

Time and money are wasted on flashy gadgets and ideas that need to be practical and cost-effective in the long run.

In Japan where the longest living people live, certified general practitioners (GPs) are at the pinnacle of providing a scalable, affordable patient-centered solution. They have discovered that fragmented specialist care is ineffective.

Detailed written guidelines with funding on how to provide holistic, patient-centered care are what general practitioners now need.

There are models that work

It has been achieved in the equally complex worlds of the legal, accounting, and aviation industries. There is no perfect system, but these are far superior to the existing global and local medical and healthcare professions.

It is worth stealing (pardon the pun) from their playbooks.

First, start with open and transparent, peer-reviewed, contextualised patient-centred healthcare and ethical standards.

This will allow the medical and healthcare professions to self-regulate. This is not new. For many years, it has existed in the global accounting and aviation industries.

The lack of global or nationwide policy consistency for COVID-19 mask mandates, all the way up to ambulance ramping, are clear indicators that the public believes the healthcare system is in trouble.

Patients are becoming more skeptical because it takes longer to see their regular doctor and because of high-profile media scandals like how the pandemic was handled, cosmetic surgery, deaths that could have been prevented, and now systemic Medicare and tax avoidance by doctors.

Doctors and their staff are nervous and are talking about quitting in droves. The backbone is leaving a system already in post-COVID-19 overload.

Alarmingly, this makes it more likely that care won’t be safe and that many deaths, injuries, and illnesses can be prevented.

The current crisis in the healthcare system is too big for any government to handle. It urgently needs the medical and healthcare professions’ help.

So what is the solution?

There are no quick fixes. We have to build a more resilient and sophisticated patient-centred healthcare system.

Now is the time to talk about the need to set up an independent healthcare standards and ethics board based on the global accounting profession. This will help reduce the crisis in the healthcare system and the unnecessary professional insecurity that scares the public and providers alike.

I am not alone. Former PSR doctor Dr Jillann Farmer sees this opportunity. In her MJA Insight+  article called Medicare compliance: seeking transparency and fairness on the 7th November 2022 she clearly states

“Adopt and promulgate the “Responsive Regulation” model championed by the Australian Taxation Office, and which earned international recognition.”

Dr. Farmer is a Brisbane-based GP, former Senior Medical Advisor for Medicare Australia, and former Medical Director of the United Nations.

Another is Professor Bill Runciman. He is a well renowned medical peer and international healthcare standards expert.

For over 30 years, Professor Runciman and his team have been charged with researching and setting healthcare standards with over $22 million in grants from the Australian National Health and Medical Research Council.

Surprisingly, when I approached him in 2014 about my principles-based solution, he agreed. Humbly, he said he missed it because, like many professions, you tend to always look bottom-up and not just top-down.

I did not believe him at the time, so I had asked for a letter of support.

It is quite clear from the letter below that he believes there is a workable model.

Why an international healthcare standards and ethics board?

The idea was born after I failed to see any improvement in Medicare’s ability to produce public Medicare rulings to help doctors and providers claim Medicare rebates.

Since the early 2000s, I have asked pro bono, both in private and in public, for Medicare to make public rulings that are open and clear so that doctors can follow the rules for Medicare billing. Many practice managers would constantly complain about the ambiguity and complexity of the rules.

“Too many pap smears”

This issue first caught my eye when I was involved in setting up a dedicated women’s clinic in the late 1990s. A Medicare audit accountant (not a lawyer or doctor) statistically accused a female doctor of doing “too many pap smears” when compared to her male colleagues.

They advised me to ask her to repay it or face the mercurial Medicare watchdog known as the Professional Services Review (PSR). I have been lobbying for change ever since.

In 2010, I called for a Federal Senate Inquiry into the Medicare Watchdog Program (PSR) to make open and transparent Medicare rulings like accountants’ public tax rulings.

I had questioned how do you prosecute someone without knowing the road rules first.

This was brought up during the 2011 Federal Professional Service Review (PSR) Federal Senate Inquiry into why the Medicare watchdog goes after doctors.

I helped set up this national inquiry. My idea of public Medicare (like tax rulings) rulings seems to have been a key point picked up in Margaret Faux’s thesis Medicare Billing thesis called Claiming and Compliance under the Medicare

Medicare Rebates will never increase in line with inflation

One thing is certain: Governments all over the world are worried about inflation. This includes medical inflation which usually travels 3 times higher than the national inflation rate.

The pandemic has run up unprecedented budget deficits. We are all being asked to live within our means. Expect higher taxes or tax crackdowns like payroll and income tax audits.

Inflation occurs when you are paid more for doing something, but there is no increase in productivity, tangible benefit, or outcome. Governments are demanding more in return for your tax dollars. It is their ultimate responsibility.

Medicare rebates have been deliberately frozen for over a decade. Where there is no real comparable measure of healthcare standards, governments from all sides are preoccupied with the medical inflation money pit.

It is fanciful thinking if you think the Medicare rebate will ever rise in line with inflation. For many years, the government has shifted toward more targeted, high-value episodic funding, such as well-documented care plans.

My guess is that they will continue to do this so long as there are clear, measurable benefits.

There is a need for healthcare standards that create a reliable measurement tool. It should clearly explain the profession’s business case and not leave it up to bean counters. Sadly, this is the current state of play, which is harming providers and patients.

Things will probably have to get worse before this idea receives support from the grassroots. It is a choice you make.

It is a choice to let the government do your bidding for you. Do not continue to be surprised if it feels like Ground Hog Day.

 

To serve or be served—that is the real question.

 

 

To serve…

We generally want to serve when we want to help someone. It feels great. It helps us fulfill our true purpose in life.

This extends beyond the four walls of your consulting room. A true professional is aware of this; it extends to teaching and supervision. It can now go to the next level by creating practical, profession-led medical and ethical standards. This should be your responsibility, not left to the government.

To be free, you should set the agenda, not the government.

To be served…

If you expect to be served, it will continue to give you a false sense of security. It means you wish to be paid without being accountable to anyone. If you stop bulk billing, you will know what I mean.

You can expect little freedom or choice to do as you please; it is a little rich to then complain that the government is manipulating, using, or abusing you or anyone else.

Remember, the purpose of medicine is not to make money. Money is important, like fuel for your car. Your car is your practice; it’s purpose is to take you somewhere. For most practices, it is there to heal and not harm people. It is time to set road rules.

I would like to know if you think this is a good idea.

If you do, please share if you care this with your colleagues and people of influence.


Skeptical TL;DR’s (Too Long;Didn’t Read please be considerate before commenting.  Beyond stereotypical responses, the real enemy of useful and meaningful debate is hubris and ignorance. 

If you’re still skeptical, I’ve been told to stick to accounting…. please keep reading. This is about holding each other accountable. Nobody has a moral monopoly or a say over our health. We should all have a say, beginning with the patient.

I am eager to learn from a more useful evidence-based alternative and welcome your insights.


 

How do professionals avoid damaging scandals in the news while making a strong  long-term business case to improve socially responsible funding for healthcare?

There is is a need for objective clinical business cases. The Indiana University has began work in this area with electronic records and drug interactions. This is the future, however from a business context it currently lacks an appropriate health information framework. 

I doubt I would have written so strongly in defence of the medical profession if it hadn’t been for Margaret Faux’s controversial  ABC 7:30 interview on Medicare fraud and waste

I used to work as a corporate fraud investigator. Until recently, the Medicare system allowed doctors to bill dead people.  A comprehensive healthcare accounting system is required to prove fraud or waste. 

There is no commonly agreed “clinically relevant” contextually defined healthcare information that is open and transparent. On that basis, it is impossible to prosecute a clinically fraud case, without a law (i.e. Health Insurance Act Act 1973) that poorly deals with this impediment. 

Unless it is really obvious, this is why no doctor has gone to jail. It is also why it is more softly referred to as “inappropriate practice” and not fraud. For the record  I do not support dishonesty. Quite the opposite.

I am not a doctor, but rather a patient and healthcare provider advocate of 30 years. I come from a family of doctors and Cambridge University genetic stem cell physicists and researchers.

This is my patient’s and accountant’s insider perspective on what it takes to fix our ailing healthcare system’s merry-go-round of problems.

As our Titanic healthcare system begins to sink, this is a useful and timely conversation we all urgently need to have.

We have finite resources; there is “no magic pudding,” yet every life is priceless until we go broke.

We need to acknowledge that there is no money tree that could fund all of our important healthcare needs. We need to ensure they are effectively allocated.

You would not spend or build or live in a house without an architect, yet the entire local and global healthcare system exists on a collection of symptomatic well-intended or no solutions.

The latest national news story on the NDIS says that there is no “magic pudding” and that the National Disability Insurance Scheme (NDIS) needs an extra $100 billion per year to work. This is much bigger than all the money Australia spends on its current health care system, and it threatens the health care system as a whole. We have to reset our priorities.

Trust but verify

The late US President Ronald Reagan famously said, in relation to nuclear disarmament, “Trust but verify.”

A useful starting point is to start building trusted accountability systems that are open and transparent to everyone including the public.

Trust is a must, or you will go bust: financially, physically, and spiritually.

Trust begins with the doctor-patient relationship. This is sacrosanct and should be protected at all times. This extends to a healthcare system that protects both patients and providers from unnecessary harm.

Trust is essential for providing high-quality care.

A lack of trust releases the hormone cortisol. The primary hormone that protects us from danger. It gets in the way of our rational limbic decision-making system, which makes it hard for a human being to trust again.

Solving the healthcare paradox

We have outstanding drugs, devices, and diagnostic services for outstanding patient care. But the delivery is not what it could or should be. The result is a sicker population, more short-term care, and costs that are a lot higher than they need to be.

This is an example of a healthcare paradox.

Let us assume you are a female GP. After seeing the 7:30 report, your loyal patient says you cheated Medicare (your patient failed to sign a bulk bill form), and AHPRA received a report about inappropriate care because you are doing “too many pap smears” when compared to male doctors.

The fact that treating a woman with cervical cancer in a public hospital costs the taxpayer more than the small cost of detecting and preventing it is completely overlooked.

You find it is irrelevant that poorly programmed computer algorithms remotely red flags you to a process-obsessed Medicare fraud regulator. The fear of an audit overwhelms you immediately. For months, you are now been obsessing over every medical record or bill. Did I complete it correctly or not?

You feel you should underbill just in case and stop seeing patients in need.

The final ignominy of what my peers think awaits, regardless of the outcome. You are treated like a medical leper. You are seen as a dodgy doctor.

Due to a simple misunderstanding, this overwhelming pressure can lead to the premature termination of a hard-to-find female doctor providing a much-needed service.

At the end of the day you work out, it is irrelevant whether you have a difficult specialty interest in women’s health or the patients themselves have never complained. Just because you are an invisible statistical outlier, you are expected to pay 100% back or else!

Surely you ask yourself could there be a simpler and better way to solve this problem.

It should be in less than one sentence, by simply saying,

“We use open and transparent patient-centred (and funded) peer reviewed commonly agreed healthcare and ethical standards endorsed by the Government, I am happy to be referred to my professional body for furthe investigation”

The unfortunate reality is that this is not the case. Commonly-agreed healthcare standards do not exist. They can never be proved or disproved by you or your professional body of peers.

Unsurprisingly, your trust and confidence in a system that does not have your back can be quite unsettling.

Your heightened awareness leads you to hear similar stories both privately and in public forums. You would not be forgiven for thinking you are all being set up to fail.

It is not enough to say, “Hey, trust me; I am a doctor.”

To protect yourself, you end up hurting both your patients and yourself. You begin to withhold clinically needed care.

This is not a hypothetical story but a real one that I have been following since the mid-1990s with a real female doctor who I had worked with to set up a women’s clinic.

In the end, demoralised she quit the clinic. Personally, I was gutted by the whole ordeal. It was next to impossible to find a female doctor. It was a terrific service.

How to reduce Medicare audit anxiety and medical negligence claims

To solve this problem, you have to build a practical, evidence-based, and principle-based healthcare business case.

It is important to show that the benefit to the taxpayer (the price of a human life) is greater than the cost of giving high-quality care based on generally accepted healthcare standards. This includes factoring in quality-of-life measures.

To keep Treasury (Medicare) happy, you need to use their language—money—to your collective advantage. You have to demonstrate a clear understanding and return on investment.

Treasury, in the PSR High Court (Wong v. Commonwealth of Australia, 2009), makes it clear Treasury needs to see a return on the taxpayers’ investment based on medical peer review.

“Doctors (are compelled) to conduct their practices with the care and skill that would be acceptable to the general body of medical practitioners”

For the greater good, the government must ensure taxpayer money is not wasted.

It is important to note that the Commonwealth cannot interfere in the doctor-patient relationship (see High Court decision). Justice Gibbs’s comments 1980 RACGP v Commonwealth.

With this in mind, Treasury would prefer or must be seen to work with the medical and healthcare professions.

For now accountants have the ear of government

It is important to note that, behind closed doors, accountants tend to have the ear of politicians more than you think. After all, the numbers do not lie. 

The accounting profession evolved in the 1800s to maintain investor confidence. Then, because of World Wars I and II, governments needed taxes and then social security to keep people from getting into trouble.

Globally, the two major professional bodies, Certified Practising Accountants (CPAs) and Chartered Accountants (CAs), were charged with doing this.

The price of human life:$20 million

So how do you build a sound ethical business case for more healthcare funding?

The first step is to put a price on human life.

This relatively easy to answer. A human life is worth $20 million. Your doctors’ capping of medical indemnity for a human life provides real evidence. This is an international insurance number. Ultimately, there has to be an insurance cap on everything.

The second step is to come up with commonly agreed-upon, contextualised patient-centred, peer-reviewed healthcare and ethical standards that can be priced to make a defendable business case for funding.

This should be used to set a benchmark price for safe care and, as a result, be a useful way to measure the return on investment. 

Professor Bill Runciman’s ground-breaking research clearly indicates we have a lot of work ahead of us. He established in 2012 that there are no universally accepted healthcare standards.

In 2017, the BMJ published the following

The real problem with funding: a lack of up-to-date peer reviewed commonly agreed national healthcare and ethical standards 

A lack of nationally agreed-upon, peer-reviewed ethical healthcare standards does more harm than good. For a long time, many, including patients, have falsely assumed that they do exist.

This leaves the whole profession open to accusations of abuse, bullying, robbery, or giving the wrong kind of care. The most serious charge that a doctor can face is causing an avoidable death.

The RACGP’s 2015 Sustainable Primary Healthcare Systems Report provides chilling evidence we have a real problem.

Without open and transparent healthcare and ethical standards, neither the government nor healthcare providers can safely pay for or keep an eye on high-quality patient-centered care.

In the meantime, it is easy and unfair for regulators to audit healthcare providers and hold them accountable for medical negligence when there are no clear road rules for anyone to follow.

It is like trying to fight a tax audit when there are no open and transparent tax rulings that enable you to comply with. It is easy to allege that someone is a tax evader, but next to impossible to prove you are not one. The burden is on you to prove you are innocent.

There is growing support

Initially, providers and/or professional groups did not seem very interested in pushing for public Medicare rulings or national healthcare and ethics standards.

This lack of appetite in relation to such an important issue has been disappointing.

I have been trying for decades on social media, even organising the 2011 Federal Senate Inquiry into the PSR.

In addition to pap smear clinics, similar problems exist with drug and alcohol, chronic disease management and Aboriginal health.

At the PSR hearings in 2011, I brought up the issue because there aren’t as many public Medicare rulings as there are tax rulings.

I had argued publicly for the first time for healthcare standards using the tax offices public ruling process.

This idea was publicly ratified by medical defence unions and senators. I had stated that this was  impacting care.

It was a place where the term “Medicare audit anxiety” grew. I came up with the term at the PSR hearing. Care was being taken away or not billed for, which hurt the patient and/or the practice’s viability.

Sadly most of the support at the time appeared somewhat tokenistic. Nothing had eventuated from the hearings. It largely fell on deaf ears.

At this inquiry, the divisive Dr. Margaret Faux drew attention to my point published in the Hansard report for her famous Ph.D that was published in 2021. 

(While I do not agree with all of her recommendations, I do appreciate the important public debate that we were unable to spark in 2011.)

“One submission by a medical defence union representative (aka David Dahm) indicated that processes should be in place to enable medical practitioners to obtain clarity about the use of the MBS and another drew a comparison between the advice and written rulings available from the Australian Taxation Office and the lack of such information and advice from Medicare, suggesting that this meant medical practitioners could unknowingly fall into error.”

In 2022, a former prominent PSR adviser shared my approach. Dr. Jillann Farmer is a Brisbane-based GP, former Senior Medical Advisor for Medicare Australia, and former Medical Director of the United Nations. In her article she clearly states 

“Adopt and promulgate the “Responsive Regulation” model championed by the Australian Taxation Office, and which earned international recognition.” 

Source:  MJA Insight+  article called Medicare compliance: seeking transparency and fairness on the 7th November 2022

As stated earlier, another preeminent peer is Professor Bill Runciman, who firmly ratifies that we have developed a comprehensive solution for the industry.

Others agree that self-regulation is a good idea.

There are many more pre-eminent leaders from MP’s to Senators and Professors.

Cognitive Bias: The medical profession are the real barrier to change

I understand why people dislike, if not fear, change. However, we are all headed down a slippery slope.

The real barrier starts with you and ends with your professional body leaders. Ironically, implementing the solution has very little to do with the government. It is embarrassing to keep blaming the government and making them do your bidding for you.

The first step is to understand the real problem and then demand a solution from your leaders.

Demand open and transparent, peer-reviewed, patient-centred standards that the government will recognise. Demand that they look deeper into this issue and do not be distracted from pithy popular narratives.

It must be included in their mandate for them to get your vote.

This will free all providers from the clandestine  government bean counter controlled environment that you love but currently fear to live and work in.

A new and compelling vision is urgently needed

It’s time for your leaders to move towards and embrace a new vision of self-regulation that works. It must be overseen by the government in a way that passes the “pub test”.

As you age and become a patient, you and your loved ones will be proud of you for contributing to the greater good beyond the four walls of your consulting room.

Contrary to popular belief, the government is eager to hear your ideas. In a democracy, it makes political and economic sense to listen to what doctors have to say that is politically palatable. The government can no longer afford big bureaucracies without increasing taxes. They do not want to go down this path again. They cannot afford to if they want to remain in power.

They know the problem is too big for them to solve on their own. The political risks of getting it wrong are too high.

We saw this in action when the AMA (a quasi-regulator) came to the medical profession’s $8 billion rorting defence. The Federal Health Minister was quick to acquit the profession of this allegation (which the mainstream media failed to report on).

It is time to treat the problem and not just the symptoms.

How to make change: Never waste a good crisis!

You would deserve an Order of Australia if, post-COVID, you were recognised for helping improve access to sustainable and socially responsible, high-quality patient-centered care.

It takes some lateral intellectual curiosity and appetite to delve into the problem, which may or may not be largely solved. Your post nominals and public social media support should give it a collective voice that everyone would be happy to share, debate, and agree or disagree with at a Saturday night dinner. In itself, this would be an achievement.

COVID-19 was preventable

We could have prevented the COVID-19 outbreak.

The lack of national, self-regulatory standards is placing us all in a harmful state of perpetual amnesia. Encouraging political and legal interference means there continues to be no formal feedback loop. We cannot discreetly learn from our mistakes or debate any alternatives without fear or favour.

We could have prevented the global impact of COVID-19 if we had a safer, non-political channel. A local and global health care system that was more open and clear would be free of special interests and political embarrassment.

Doctors and healthcare workers should not be gagged. They should have a safe place to discreetly air their concerns.

It takes a thief to catch a thief

The government understands the “it takes a thief to catch a thief” principle. Since the 1990s, it has recognised the benefits of a quasi-self-regulatory professional body.

Paul Keating of Labor came up with the principles of the Council of Australian Governments (COAG) for less red tape and rules. This sets a mandate for those seriously interested in nation-building reform. It was an invitation for your professional and industry bodies to apply so they could make your life easier.

A great example of this initiative is how the Federal AMA for constitutional reasons discussed earlier, is written into the national Health Insurance Act of 1973.

The Federal Health Minister, for example, must consult the AMA in relation to appointing doctors to the Medicare watchdog body, called the Professional Service Review (PSR) committee, for inappropriate practice.

Keeping things as they are will work until the healthcare system reaches a public breaking point that can’t be denied. Certainly, we are hearing many more loud stories of leaks on the Titanic, and we may be closer than you think.

You have to urgently and permanently resolve this trust impasse.

It only takes one influential and visionary leader of a professional group to realise that building a story that can be sold around the world is a great way to start a new beginning.

The global accounting field is a great example of how a leader should handle a crisis.

Following many systemic high-profile corporate failures of the 1980s, the former national president of the Institute of Chartered Accountants of Australia successfully pushed the case for a unique The Accounting Professional & Ethical Standards Board (APESB), which has since gone global. 

They recognised that if they did nothing, the government would be the real enemy. At the time the government was forced to implement costly and time-consuming regulations, which it did.Many of these were later removed, once the profession was able to demonstrate it could self-regulate itself.

The not for profit international healthcare standards and ethics board based on this successful model will help govern the entire medical and healthcare sector. It is a local and a global government market tested solution.

The ultimate irony

The irony of the latest rorting story that has hurts industry morale is that it could have been prevented.

Einstein said it well when he defined insanity 

Where do we go from here?

Despite receiving the who’s who of support from influential people from all walks of life only those in real power i.e. AMA can make the difference. 

After consulting with Professor Bill Runciman in 2016, he has provided a way forward that requires standards to be adapted by the relevant professional bodies, which I will continue to advocate for.

Once we fix this, then we can ask the IT industry to use and pay for the use of this foundation to provide more useful and meaningful data in your consulting room.

This is how the global and local accounting professions have evolved since the 1930 stock market crash. It is a tried-and-tested model. After too many plane crashes made the news in 1945, the aviation industry followed a similar path by setting its own rules.

For doctors it is a choice; it is what patients expect. Professionals must accept responsibility for doing their work for them and for themselves.

If you didn’t do this, you wouldn’t be meeting your duty of care, which goes beyond the consulting room.

It is the difference between being a member of a trade or a profession. A true professional recognises that they have a duty of care to the public, not just themselves.

You should never leave this gate open for others who are less qualified or responsible to set the agenda. Anything less would be considered complicity.

I am happy to be proven wrong. The wheels of progress turn ever so slowly.

Until then, things will need to go from bad to worse before we see any real change. Sadly, it may be sometime before a Kardashian will have to die of a preventable death before anybody takes notice.

The excuses “I don’t have time,” “I’m not interested,” and “I don’t know” will continue to make the media and the public angry.

Until then, I expect our front line will have a new cross to bear when the next unfortunate scandal is aired on 60 Minutes.

Kudos to you if you can leave it in a better place than where you found it.

Why do I care?

As a final disclosure, I became a patient and provider advocate after my car accident in 1989.

On a Tuesday morning at 5:30 a.m., I fell asleep behind the wheel after working long hours. Nine operations later and a lot of rehab later, I am thankful for the people that looked after me.

Despite coming from a well-educated and connected medical family, I still found it impossible for patients to navigate this system. 

I do not blame the hardworking doctors, nurses, and support staff.

For over thirty years working nationally and exclusively in the medical and healthcare system, I feel there have been some remarkable advances; however, many other areas have gone from bad to worse, which is harmful to all of us. 

The media is not the problem; they are echoing the symptoms of a deeper problem we all need to solve together.

It is time to stop this insanity. For more information, go to the International Healthcare Standards and Ethics Board website (www.ihseb.org), a not-for-profit project, or reach out to me. 

If you are now convinced, begin to share and discuss this article with your colleagues and friends. We all thank you in advance. 

For more insights visit our blog.

About me: David Dahm BA (Acc.), CA., FCPA, CTA, FFin, CPM, FAAPM, FAIM, FGLF.

Chartered Accountant, Chartered Tax Adviser, Registered Tax Agent, Former AGPAL Surveyor 10 years of service

David Dahm is CEO and founder of the national medical and healthcare chartered accounting firm Health and Life and global Founder and CEO of the not for profit project the International Healthcare Standards and Ethics Board (www.ihseb.org)

After a serious work related car accident in 1989, and nine operations later I continue to be a patient and provider advocate. I enter my third decade as a national Chartered Accountant for Medical and Healthcare practices in Australia. I am a former 10-year Australian General Practice Accreditation surveyor. I come from a medico family. I have served on the AAPM national Board and was the inaugural national Chair of the Certified Practice Manager CPM post nominal. I continue to provide accounting tax and practice management advice to many practices all over Australia.

You know who you are and I thank you for this real honour and privilege to serve you and your community through you. Note, I am not a lawyer please seek appropriate legal and accounting advice. This information is for general information and discussion only.

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