Blog No. 173 - Senator Griff Intervenes to Help: 11 February 2025

Senator Griff tried to help and got nowhere.

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Margaret and I in Connemara, Ireland in August 2017

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Connemara, Western Ieland in August 2017.

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My Request to Senator Griff

My formal complaints to ASIC and ACCC were preceded by less formal approaches to get the law enforced.

I emailed a letter to Senator Griff at 5.31 pm on Monday 7 February 2022 saying this.

I am now aware that other cancer patients who have had difficulty in obtaining any payments from their health insurers have made formal complaints to the Honourable Steve Georganas MHR and the Honourable Nicolle Flint MHR.   Your efforts to assist Margaret and myself may be enhanced by co-operation with Mr Georganas and Ms Flint.  In addition to HCF, it seems that Teachers’ Health Insurance Fund has also refused to pay claims for services provide by Lift Cancer Care Services.  It appears that Teachers’ Health fund has been almost as difficult to deal with as HCF – and just as evasive as HCF in relation to providing reasons for their refusal to honour claims for services provide by Lift. … Anything that you, Ms Flint and/ or Mr Georganas is able to do to assist Margaret and the other cancer patients who are affected by this horrible little saga will be very much appreciated.

In my letter to Senator Griff, I included copies of my letters dated 7 February 2022 to HCF and the Ombudsman.

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Senator Griff rang me on Tuesday 8 February) saying he had received an email from the Minister for Health which he forwarded to me.  I got the email at 7:22 pm on 8 February.

In fact, the Minister already knew all there was to know about the health insurance scam and had decided to ignore it.  Under the legislation, the Minister was the ONLY person who could directly enforce the law – and Minister Greg Hunt refused to do this.

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Health Minister’s Reply

This is an exact copy of the answer given on behalf of Health Minister Greg Hunt to Senator Griff.  The Minister’s response is a perfect example of Bulls**t Baffles Brains.  The Minister never gave any further response. 

Please see advice below, which may also assist with engaging further directly with HCF: Mr Hankin has complained that HCF has paid benefits for some services provided by Lift Cancer Care Services (Lift), but not others. As at 28 January 2022, Lift is a Commonwealth declared hospital with second-tier approval status as a G category hospital (a private hospital that provides episodes of hospital treatment only for periods of not more than 24 hours) until May 2022. The claims submitted to HCF for Ms Redden are for MBS items 24 and 37, which are considered type C procedures in the Private Health Insurance (Benefit Requirement) Rules 2011. MBS item 24 is professional attendance by a general practitioner lasting less than 20 minutes MBS item 37 is professional attendance by a general practitioner lasting at least 20 minutes. The Rules describe type C procedures as procedures or services that do not normally require hospital treatment. The Rules also set out the minimum default accommodation benefits that private health insurers should pay for hospital treatment, based on the MBS items for the procedure performed, or service provided, by a medical practitioner. Benefits for day-only accommodation are payable for patients receiving a type C procedure only if certification is provided. Certification must include: sufficient information to identify the patient, the certifying medical practitioner and the specific medical procedure being certified details of the patient’s medical condition, or the special circumstances relevant to the specific procedure, that the medical practitioner is certifying require it to be performed in a hospital a signed statement to the effect that the medical practitioner certifies that it would be contrary to accepted medical practice to provide the procedure unless the patient is given hospital treatment that does not include part of an overnight stay. Insurers have an administrative obligation to check the validity of certification documentation to ensure it meets the requirements as set out in the Rules and the procedure, or service, is covered by a patient’s private health insurance policy. The Rules do not provide for insurers to assert a clinical assessment or judgment of a patient’s medical condition/s or special circumstances certified by a medical practitioner. If an insurer rejects a type C certification, for any reason other than that it fails to meet the requirements prescribed in the Rules, or that the proposed procedure is not covered by the patient’s health insurance policy, the insurer is in breach of the Rules. Claims rejected by HCF, it argues, are because the services provided to Ms Redden were not hospital treatment. The Department of Health is aware of disputes between Lift and HCF about certification, and has and continues to engage with both parties in an attempt to resolve the disputes. More broadly, the Department continues to work with the private health industry sector to influence improved communication and processes, to prevent disputes between parties such as this protracted dispute. While it is appropriate that medical practitioners have clinical autonomy, it is equally important that sufficiently transparent and accountable processes are developed for clinical decision-making, to limit the potential for inappropriate practices and protracted negotiations around payment of benefits. The 2021-22 Budget included a reform measure to address ongoing stakeholder concerns and disputes over what are considered appropriate hospital certification processes in private hospitals: https://www.health.gov.au/sites/default/files/documents/2021/05/private-health-insurance-improving-affordability-and-sustainability-of-private-health-insurance.pdf A key aspect of the measure is the development of a Bill that would seek to expand the authority and functions of the Professional Services Review Agency (PSR), to review potential inappropriate practices by medical practitioners and associated hospitals, when certifying that type C medical treatments, or services, are required to be delivered in hospital. Another key aspect of the reform measure is encouraging medical colleges to create clinical guidelines on what is accepted medical practice in Australia and the circumstances in which admitted hospital treatment (type C certification) is appropriate for services normally provided out of hospital.”

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Don’t try understanding the Minister’s email.  It is unintelligible.

Health Minister Greg Hunt already knew ALL relevant facts about the health insurers – and he would not enforce the law.  He was not seeking re-election and didn’t care.  Sir Humphrey Appleby from “Yes Minister” would have approved the opening words of the email.

Please see advice below, which may also assist with engaging further directly with HCF.

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The Minister was declaring in Bulls**t Baffles Brains language that he was never going to help in any way.

 

Blog No. 172 - Australian Securities and Investment Commission: 11 February 2025

Left to right – Margaret, her “Best Friend” Anne Ryan, her other “Best Friend” Sue Chapman, me and Peter Hussey the “wonderful” Irish friend of Margaret and me both.  This photo was taken at Goolwa on the 16th of February 2019, a year before Margaret became gravely ill.

Anne Ryan refused to come to Margaret’s funeral, but sent a video eulogy in which she never mentioned my name

Sue Chapman reluctantly came to the funeral but made sure I never laid eyes on her.  She refused to give a eulogy.

Peter Hussey sent a video eulogy in which he never mentioned my name.

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Margaret at Goolwa on the 16th of February 2019.

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Complaining to ASIC

By April 2022, I had completely lost patience with the unlawful conduct of the health insurers.  ACCC was only one of many complaint avenues that I explored.  I hoped if I complained long and often to a wide array of agencies, one agency might eventually decide to do help.  The Australian Securities and Investments Commission (ASIC) has responsibility for ensuring that companies obey company law obligations.  When a company Director ignores Director obligations, ASIC can take legal action.

I searched the ASIC website and wrote a letter to the “Misconduct and Breach Reporting and the Office of the Whistleblower” at ASIC.  A copy of my letter to ASIC can be accessed through the link attached to this blog.

Letter to Brendan Facey (ASIC)

Annexe to the letter sent to Brendan Facey

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This summarises my ASIC communications in April and May 2022.

Communication Details	Correspondence Length	How Sent	Response Date	Response Length	Response Said
Letter of complaint to ASIC dated 18 April 2022 sent by mail to: Mr Brendan Facey Senior Executive Leader, Misconduct and Breach Reporting and Office of the Whistleblower Australian Securities and Investments Commission GPO Box 9827 BRISBANE Queensland 4001	13 pages	Sent by sent by mail to: Mr Brendan Facey Senior Executive Leader, Misconduct and Breach Reporting and Office of the Whistleblower Australian Securities and Investments Commission GPO Box 9827 BRISBANE Queensland 4001	16 May 2022	18 lines	Bugger off; we are not interested
Email received on 16 May 2022 from Shay Thananjeyan at ASIC	18 lines	Email from Shay.Thananjeyan@asic.gov.au at 5:35 pm on Monday 16 May 2022	Waste of time trying to respond to ASIC	Zero length	No need to respond to ASIC email saying bugger off, we are not interested

I received no reply from ASIC in April 2022, but I did get a short email response on the 16th of May 2022.

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16 May 2022 ASIC Email

In summary, the ASIC email from ASIC of 16 May 2022 said this.  

Bugger off.  We are not interested.

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This is the complete ASIC 16 May 2022 email. 

Your Report of Misconduct - The Hospitals Contribution Fund of Australia Ltd ACN 000 026 746 [SEC=OFFICIAL] Our Reference: CAS-98267-T6D5J1 Dear Mr Hankin THE HOSPITALS CONTRIBUTION FUND OF AUSTRALIA LTD N I B HEALTH FUNDS LTD  TEACHERS FEDERATION HEALTH LTD (the Companies) We refer to your report of misconduct to ASIC dated 18 April 2022. We note that you are in a dispute with the Companies about a private health insurance claim and that you also raise concerns about misleading and deceptive conduct in relation to private health insurance policies. You also raise concerns of cartel behaviour within the private health insurance industry. Thank you for bringing these issues to our attention. Your information, and information provided by others when they report misconduct to ASIC, gives us an understanding of conduct occurring in the marketplace and assists us to identify the best areas to focus our resources. We considered your information against a range of factors (which are set out in our Information Sheet 153 How ASIC deals with reports of misconduct and Information Sheet 151 ASIC’s approach to enforcement) and have determined we will not take action at this time. Your information has been recorded on our internal database. This will assist us if we receive information which raises similar issues in the future. What you can do We note that you have already raised your dispute with The Hospitals Contribution Fund of Australia Ltd with the Commonwealth Ombudsman which is the appropriate avenue. You may wish to consider seeking legal advice should you wish to pursue a review of the Ombudsman’s decision; Review of your complaint outcome - Commonwealth Ombudsman.  You may also wish to raise your underlying concerns with Australian Prudential Regulation Authority (APRA) who may have jurisdiction in this area; APRA. Concerns regarding potential cartel conduct within the insurance industry may be directed to the Australian Competition and Consumer Commission; ACCC. If are uncertain about what private action may be available to you to resolve your dispute, you may wish to seek legal advice. If you are unsure about how to access legal advice, contact the Law Society in your state or territory. Please see www.moneysmart.gov.au for information about free legal advisors which may be of assistance to you. ASIC must protect from unauthorised use or disclosure of any information given to it in confidence, including details of your report of misconduct. Accordingly, it is more appropriate that you contact the above agencies directly with your concerns. Please find a link to ‘How ASIC deals with reports of misconduct’, which is an easy-to-read guide about ASIC’s responsibilities and the process we use for assessing your report. We hope you find it helpful in understanding what steps ASIC takes when it receives reports of misconduct.  Thank you for talking the time to report your concerns with ASIC. Kind regards Shay  Shay Thananjeyan Analyst, Misconduct & Breach Reporting Australian Securities and Investments Commission 120 Collins Street, Melbourne, 3000 shay.thananjeyan@asic.gov.au

Like the Commonwealth Ombudsman, ASIC had zero interest in whether or not the health insurers were breaking the law.  I reluctantly decided that trying to achieve anything through ASIC would be a waste of time and energy.  I made no further attempt to persuade ASIC to do its job.

I wondered why it was that these highly paid bureaucrats did not give a damn about the welfare of their fellow Australians.  Was it truly the case that no bureaucrats were interested in doing the jobs they were (theoretically) paid to do?

Given my miserable experience with ASIC, no wonder it has such a poor reputation as a government regulator.  If there are any officers in ASIC who genuinely want to do their jobs, I suspect they eventually give up in disgust, knowing it is a Mission Impossible.  Tom Cruise should make a movie about a genuine Mission Impossible instead of the fantasy movies he usually makes.

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Finding any government bureaucrats who would do the job they were paid to do, eventually proved impossible.