Doctors billing millions, claiming impossible 25-hour days in “porous” system
An audit of NSW’s porous payment system for contractor doctors reveals one doctor charged taxpayers $3.5 million and another billed the equivalent of five full-time roles in a single year.
The NSW Auditor General’s report, published on Thursday, warned that NSW Health’s “significant and persistent weaknesses” in its charging processes for 8000 visiting medical officers (VMOs) left it exposed to errors and fraud.
A doctor requested payment for 9250 hours of work in 2024-2025; This is an impossible feat considering it would be the equivalent of working 25.3 hours a day, every day of the year.
NSW spent $1.32 billion on claims from VMOs that provide essential services in the public system, particularly in regional and rural areas where medical services struggle to recruit and retain staff.
But the audit office found that NSW Health’s “failures” to effectively monitor VMO payments, compliance and “emerging risks” allowed some doctors to double-pay by billing multiple local health districts for the same working hours.
The five top-billed VMOs earned between $1.6 million and $3.5 million in 2024-25, with 93 VMOs billed as the equivalent of 1.5 full-time roles.
The report said VMO recruitments were largely temporary solutions rather than long-term strategic planning, with little consideration for value for money, and VMO spending was rising by more than 10 per cent annually.
The South Western Sydney LHD outperformed rural and regional LHDs by paying more than $405 million to VMOs.
Australian Medical Association (AMA) NSW vice president Dr Fred Betros said increased VMO spending reflected rising patient demand and increasing pressure on the public hospital system.
Betros said VMO decisions and associated awards were “outdated and no longer fit for purpose” and that “lack of oversight and governance is a significant problem”.
The report also found a breakdown in “separation of duties,” with more than $10 million paid for requests in which the same person performed both control and approval functions, and extensive use of “miscellaneous” requests.
NSW Health paid out more than $300 million to anesthetist VMOs; this became the top billing specialty overall.
Betros said this is not surprising, considering anesthesiologists are essential in every surgery performed.
GPs were the next group to bill more than $172 million amid a shortage of GPs in the regions and Sydney’s outer suburbs.
VMO psychiatrists, appointed in large numbers after staff specialist psychiatrists resigned in 2025 during a protracted dispute with the Minn. government, racked up bills of almost $127 million.
More than $5.5 million was paid to VMOs for services More than $5.5 million was paid to VMOs for services provided two years or more before the invoice date, contrary to NSW Health policy
NSW Health has accepted the report’s recommendations, including strengthening VMO charge management and establishing mandatory checks for local health districts.
A NSW Health spokesperson said VMO spending supports critical clinical services that could not be provided without them.
The spokesman said NSW Health was committed to improving oversight and protecting public funds and had established new safeguards, including a statewide VMO compliance dashboard.
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