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Department probed on ACFI changes

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The issuing of $10,800 fines for repeated false claims under the Aged Care Funding Instrument (ACFI) will be a measure of last resort and likely to be used rarely, the Department of Health has said.

The department told a Senate estimates hearing this week that education, auditing, formal notification and reappraisal would be pursued with an aged care provider before a fine was issued.

Fiona Buffinton, first assistant secretary, access, quality and compliance, told the hearing on Wednesday that the issuing of a fine would be “very exceptional.”

“If you look in recent years there would hardly be any cases of it, but it’s just making sure that proportionately we have all levels of compliance available to us,” she said.

The department could not tell the committee how many audited claims had been found to be deliberately false.

As part of the stronger compliance measures announced in the Mid-Year Economic and Fiscal Outlook, the department said it would be investing in improved IT and data capacity to better target its auditing processes.

“Instead of 20,000 light touch audits [a year], we will probably have a few less than 20,000 but a number that are much more detailed and through that we will learn a lot more about the program,” said Ms Buffinton.

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Fiona Buffinton, Department of Health

She said that the department wanted to focus more of its compliance activities on high-risk providers.

Increased scrutiny would have both a deterrence effect, by encouraging providers to pay more attention to the accuracy of their claiming, and support identifying patterns of concern, Ms Buffinton said.

For the first time, requests to reconsider a department’s decision to downgrade a claim will incur a fee should the department’s position be upheld.

The government’s increased compliance measures are estimated to generate $61.9 million over four years.

By far the biggest area of savings – $475 million over four years – will come from amending the ACFI’s complex healthcare domain.

The department said it was working with the sector and clinical experts to redesign the complex healthcare domain, which would make the criteria for claiming at the higher levels “more stringent.”

“What we will be looking at is the criteria by which aged care services get to the higher price for complex care needs, so making that test more rigorous then it would otherwise have been,” said Nick Hartland, first assistant secretary, aged care policy and reform.

The department reiterated its position that growth in ACFI expenditure was “unanticipated” and cannot be explained by a growth in the frailty of residents, which is refuted by provider peaks.

Mr Hartland said the funding instrument was being used in a way that was not intended.

The minister has previously referred to “sharp practices.”

The department had been discussing the ACFI overspend and its cause with the sector’s expenditure working group since the middle of last year.

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4 Responses to Department probed on ACFI changes

  1. Paul February 12, 2016 at 4:59 pm #

    So why put the fine there in the first place.

    I really worry about the logic of our policy makers

  2. Kylie Wise February 15, 2016 at 11:53 pm #

    So who do we believe?

    In her December press release, the Minister stated she had ‘seen a concerning number of incorrect claims’ and wanted to ‘protect the integrity of Australia’s aged care sector’

    Now the First Assistant Secretary reckons they’ll hardly ever issue a fine.

    Sounds like they’ve decided its all too hard so let’s just chop ACFI again (we got away with it last time). We know Treasury got their numbers wrong but lets stick with a flawed model and keep trying to fit the care to the budget rather than budget for the care.

    Of course ACFI rorting is commonplace; it practically begs you to do it. Just look at some of the claimable items in Question 12. Protective bandaging, heat packs and enemas were recommended by the same expert that gave us aromatherapy in the RCS. And wasn’t it amazing to witness aromatherapy’s meteoric rise? Almost as amazing as its decline when the funding ceased.

    But dont slam everyone. If you’re serious about targeting dodgey 4b claims, why not start with the ones using a first year O.T. instead of a Physio. And while you’re there, ask them how one person manages to give 75 residents 4 treatments each per week ?

    Better still, why not revise the Question 12 items to include treatments that actually provide real benefits instead of passive, ineffective practices that promote decline rather than improvement. Or is all this active ageing, re-enablement and wellness stuff just window dressing and hot air?

  3. Melleah Strautins February 17, 2016 at 1:25 am #

    Having worked in Aged care facilities using OT assistants with no mental health background to deliver cognitive assessments is where your money is going. Residents with little to no level of cognitive decline being rated at higher levels than needed to garner more funding, whilst the allied health professionals list has no mention of qualified mental health practitioners.
    There’s much research outlining the high rates of anxiety, depression and substance abuse in residential care, yet medicine used to sedate rather than pay for a professional. The humanistic approach is no where to be seen.
    Needless to say when I refused to sign off on an incorrect assessment, my casual hours were reduced to almost nothing and then were officially ceased once I completed my degree stating I could no longer be afforded.
    The system is flawed and limited with restrictive budgets. However, with the World Health Organisation recognising the growing rates of older adults I remain hopeful that governments will be forced to address these issues sooner rather than later.

  4. Maireid February 22, 2016 at 10:38 pm #

    What about an ACFI manager of one large organisation that met with staff and gave the following interpretation of incontinence – when any lady comes into the facility and they have a dribble they are to be classed as having high care incontinence. When several staff stood up and said that this would be false reporting – the answer came back “you want me to lose my job” “you may as well get out”. How absolutely disgusting.

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