Private Health Funds Accused of Misusing Patient Data for Commercial Gain

Michael Bailey | AFR Magazine | July 25, 2016

Private health insurers that also own dental surgeries are misusing data obtained through the HICAPS claiming system for commercial benefit, the Australian Dental Association has warned a Productivity Commission inquiry into expanded data sharing. The inquiry, for which submissions close on July 29, is examining the benefits and costs of data being shared more widely between public sector agencies, private sector organisations, the research sector, academics and the community.

In a submission by Australian Dental Association (ADA) president Dr Rick Olive, the peak body said the way some private health insurers were already behaving should be a warning on the perils of data sharing. Dr Olive said contracts between dentists and private health insurers had clauses relating to the use of confidential information in HICAPS, which were "too generous" to insurers. They are allowed to access data about the charging practises of individual dentists and practices which use the HICAPS system, and drill down to analyse the specific procedures performed and the identity of patients receiving them.

"This enables insurers … especially those that are vertically integrated and operate practices owned by them … to have access to sensitive information and be able to act on this information to increase their competitiveness," the submission says. "It enables the insurers to identify suitable members it can then 'steer' to insurer-owned dental clinics, either by way of pricing signals, such as level of rebate, or contractually in the terms and conditions of policies"...