‘Unscrupulous actors’ were put on blast in an ABC investigation which alleged companies serving veterans billed the DVA for care that wasn’t delivered.
ABC Four Corners’ ‘Defenceless’, which aired on Monday, has put veteran-focused telehealth services under fire, alleging they are “squeezing veterans and taxpayers to maximise profits”.
The investigation found “multiple examples” of operators signing up veterans for treatment and persuading them to move their Coordinated Veterans’ Care (CVC) program away from their regular GP.
In another instance, in-house GPs within the ecosystem were allegedly signing off on referrals without seeing patients.
The Four Corners report focused on the Veteran Benefits Australia (VBA) group, which is based in Brisbane and comprised a network of more than 70 companies, dozens providing veteran health services.
It reported that an internal email from as early as 2022 allegedly showed the network’s marketing business had amassed 180,000 veterans’ details in a database shared across the ecosystem and used as sales leads.
Alleged aggressive marketing tactics included competitions and freebies such as headphones, smartwatches and holidays, all of which required participants to submit their DVA details.
The program also reported that 19 providers charged a total of $114 million for medical reports, roughly $6600 per report, to help the DVA make decisions about support.
RACGP rural chair Associate Professor Michael Clements, a veteran and Townsville practice owner who said he often received marketing from companies like VBA, told The Medical Republic he was relieved the Four Corners program had brought the issues “out in the open”.
“To have companies like this just flagrantly committing fraud and pushing medical treatments and pushing medications onto people just for the pure profit is scary,” he said.
Professor Clements, who regularly treats veterans, told TMR his patients had received boxes of cannabis products they often didn’t need and marketing alerts from vertically integrated telehealth companies – including ketamine, psilocybin and cannabis providers – during consultations.
In another instance, one of his patients received a telehealth consultation with a social worker, physiotherapist, and exercise physiologist, none of which were necessary, for shin splints.
“The DVA has had regular meetings with the college to see how it can best support GPs,” he said.
However, he urged better tracking of spending on veterans’ behalf, including alerts when their white or gold card was used. He also encouraged GPs to advise the veteran patients to check what services had been billed in their name through the myGov app.
“There should be more explicit consent when their cards are being used because most veterans don’t even know that this money’s being spent against their name,” Professor Clements said.
Introducing the $5000 DVA allied health threshold to take effect from 1 July 2027, which was quickly scrapped following veteran protest, would have been a measure to curb predatory billing practices, Professor Clements said.
Four Corners alleged a campaign against the threshold was partly funded by VBA.
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Professor Brad Murphy, a rural generalist and veteran, told TMR it was harder to detect introductory services, “matchmakers” – like the Veteran Benefits Australia ecosystem, which connected services with veterans’ details and received a percentage of the commission.
Practitioners are responsible for every item number claimed in their name, making it more difficult to hold larger corporations to account, Four Corners reported.
Another complication, Professor Murphy told TMR, was that regulation moved slowly from the DVA through to AHPRA and the ACCC, which could give fraudulent companies time to reconstitute as a different entity, requiring the process to start again.
He said it was a disservice to GPs who provide legitimate veteran care, often operating at a significant loss compared to privately billing patients.
While he agreed better monitoring was necessary, he cautioned against over-regulation that made systems harder to access, warning it could disincentivise GPs and specialists from treating veterans or lead practitioners to require veterans to pay upfront and follow up their own claims.
“Some veterans just don’t have disposable income to be able to do that,” Professor Murphy said.
“It’s a cumbersome system, and we need to be helping veterans access those services,” he said.
Professor Murphy proposed allocating money from the CVC program to a standard, comprehensive medical provider, or accrediting practices, as another deterrent to bad actors.
“If we could promote education, support and incentives for practices to create gold standard skills in identifying and working with veterans, and reward them accordingly by making sure they do get their CVC money and they’re not fighting for it because a ‘bad actor’ has claimed it inappropriately – those sorts of systems go to the core of fixing this problem, but they also then encourage GPs to engage with veterans,” he said.
Dr Murphy said it was important to reaffirm the vast majority of healthcare providers have veterans’ best interests at heart.
“The work I see from senior leadership within DVA shows they’re trying hard to make this work, and no one ever dreamed anyone would profit off a veterans’ service, let alone other veterans. And that’s why many of these checks and balances weren’t there, because up until recently there’s been an essence of trust in the system. And clearly, that was misplaced.”
Earlier this year, the DVA introduced tighter restrictions on cannabis prescribing, including THC dosage and concentration, and requiring in-person consultations.
According to Four Corners, one veteran described receiving a THC dose that rose from 25mg to over 1,200mg a day, through DVA funding following nurse-led consults. He reported never having spoken to the prescribing doctor, and was hospitalised for three months.
Dr Hester Wilson, RACGP addiction medicine group chair and contributor to a DVA medical cannabis and chronic pain guideline, said patients must be warned about unapproved medicines’ risks, especially when virtual, vertically integrated services deliver “outrageously poor” care.
“If you’re caring for someone who is a veteran who has mental health issues, PTSD, chronic pain, you absolutely want to ensure that the service that’s managing medicinal cannabis has conversations with you and that there’s collaborative care,” she said.
In February this year, the government announced a $203.1 million investment to strengthen provider integrity and professional advocacy arrangements, including $151 million to expand DVA’s capabilities in prevention, detection and enforcement.
In response to the Four Corners program, the DVA described the allegations of misconduct and fraud as “deeply concerning” and encouraged those with provider integrity concerns and evidence to report them to the DVA.
