Woman jailed for 55 counts of Medicare fraud

[Guest Nicole]

A WOMAN who rorted the Medicare system for 10's of thousands of dollars will spend the next six months behind bars.

Narelle Gourley, 40, pleaded guilty in Rockhampton District Court on Thursday to 55 counts of fraud.

The court heard Gourley owned a medical practice from January 2012 to December 2012 and in that time fraudulently claimed $64,937 from Medicare by completing health care plans for patients and receiving the rebate despite not being a doctor.

The claims were sent electronically to Medicare and the rebates were paid into the practice's account bank account to which Gourley was the sole signatory.

In that time she administered health assessments, chronic disease assessments and Aboriginal and Torres Strait Islander health care plans.

The mother-of-two cried silently in the docks for the duration of the sentencing while her partner of three years sat in the gallery supporting her.

The court heard from the Director of Public Prosecutions and defence barrister Maree Willey the details of Gourley's offending and life.

Gourley's troubled life began in Victoria where she was raised in a strict household as the daughter of a Speaker in the church of Jehovah's Witnesses.

She left school in Year 10, then and at the age of 19, moved up in the church to the role of Pioneer, door knocking for her faith for up to 90 hours a month while working a part time job.

At the age of 21, Gourley had a daughter and when she was three-years-old moved to Murgon and got her first job in a medical practice.

She then went on to work at QML pathology in Rockhampton for five years.

In 2011 Gourley became practice manager at the Ross Medical Centre and when the head practitioner retired in early 2012, she bought the business for $150,000.

She was forced to relocate the practice to Mount Morgan and it was renamed the Mount Morgan Medical Centre.

The unwillingness of doctors to travel to Mount Morgan meant Gourley was paying practitioners up to $5000 a week, even hiring them cars to travel to work.

During this time, Gourley's marriage to the father of her son was breaking down, culminating in her attempting suicide and leaving her faith.

Gourley eventually sold her practice in June 2013 for $250,000, and has since filed for bankruptcy in June of this year.

In August 2012, Centrelink received a number of complaints from Mount Morgan Medical Centre patients regarding health care plans.

In some cases patients were unaware claims had been made in their name and in other cases they said they had never seen a practitioner.

An additional complaint was received from a doctor working at the Mount Morgan Medical Centre who noticed services been billed under their provider number that they knew hadn't been provided to patients.

Investigations into the fraud commenced in October 2012.

Doctors and receptionists gave evidence to police that Gourley looked after all the medical practitioners' billing and would take patients in for private consultations to complete health care assessments for them.

Gourley used the provider numbers of three doctors to process her fraudulent claims.

One of the doctors grew suspicious when their provider number had been used to process 19 health care plans despite never having worked at the Mount Morgan Medical Centre.

The doctor in question worked at the practice's predecessor, the Ross Medical Centre, for two weeks.

These 19 claims resulted in fraudulent rebates totalling $18,971.

The second doctor, who made the initial complaint, had 18 claims made using their provider number, leading to $20,147 being paid out from Medicare.

The third doctor also had 18 claims made against their name, and unlike the other doctors, signed off on the health care plans on a number of occasions.

They had previously worked for the Australian Defence Force and were unaware of how the Medicare system worked, thinking the plans looked reasonable.

Although there were 55 fraudulent claims made, several services were 'batched' in each claim, meaning the actual number was higher.

Despite the financial gain from this racketeering, Gourley did not use the money to enhance her own life, but fed it back into the business.

Ms Willey argued although her client filled out the health care plans, the patients were still receiving the services.

Judge Burnett rejected this notion, saying the plans by definition had to be signed by a doctor.

Adding even if patients received the services down the track, it was unclear if they actually required the service.

Gourley was given a head sentence of two years and will spend six months behind bars.

After this time she will be released on a $1000 bond on her own recognisance with a good behaviour period of four years.

No reparation has been ordered, but it is not yet apparent if Centrelink will take civil action against Gourley for damages.

http://www.frasercoastchronicle.com.au/news/woman-jailed-for-55-counts-of-medicare-fraud/3091451/