Exclusive: Documents reveal IHMS, contracted for health services for asylum seekers on Nauru and Manus, failed to meet medical targets

This article is more than 4 years old

This article is more than 4 years old

Australia’s immigration department failed to appropriately oversee the multinational that provides healthcare for asylum seekers and was unable to cope with the “commercially aggressive practices” that led to numerous failures to meet medical benchmarks, a series of damning internal reviews have found.

The findings substantiated a number of key allegations published by Guardian Australia in July 2015 about the relationship between International Health and Medical Services and the immigration department.

Leaked documents showed IHMS failed to meet medical targets, deliberately included incorrect data in reports and admitted it was “inevitable” fraud would occur as it tried to meet government standards. The documents also revealed that IHMS failed to undertake working with children checks and police checks on Manus Island.

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Three reviews were commissioned by the immigration department to examine the allegations. Two were internal and one was to be conducted by KPMG.

IHMS, a subsidiary of the global healthcare giant International SOS, has received more than $1.6bn in government funding to provide asylum seeker healthcare in Australia and on Manus Island and Nauru.

The detention assurance review team report, released under freedom of information, which drew together findings from the KPMG audit and the first initial internal audit, said: “Through the review processes, both internal and external reviews agree that IHMS took an approach of seeking to maximise profits, including through actively reducing opportunities for the department to seek contract abatements.”

It later continued: “There is a fundamental conflict between contractual and clinical objectives where profit and cost dictate clinical operations.”

The review acknowledges that the series of contracts set up to manage IHMS were simply unable to adequately meet the expansion of asylum seeker health services needed as the detention population increased over the past five years.

“The department acknowledges that the existing contract was not designed for this volume and that the service delivery and staffing models for IHMS were subsequently modified to meet demand faster than good governance would normally allow,” the review said.

The reviews break the allegations raised in the reports down into eight distinct issues. Of the most serious allegations surrounding the high risk of systemic fraud within IHMS, the reviews stated that they did not identify evidence of widespread fraud. They said the slide published by Guardian Australia containing this allegation was “aimed at educating the audience on the contractual performance requirements, the abatements scheme”.

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IHMS also told the reviewers there was no evidence the slide had been presented. The KPMG review said: “IHMS could not identify any meeting where this presentation was used.

“The lead analyst at the time (who has since left) often produced ad hoc presentations of his own volition designed to illustrate risks. Not all resulted in formal presentations and it was the view of one analyst, crafted to attract attention.

“The analyst was well-motivated but often used emotive and inappropriate language.”

But it acknowledged there were major deficiencies in the oversight of the healthcare contract that dramatically exacerbated fraud risks. It said that until 2012 no clear monitoring of IHMS was undertaken for the department.

The KPMG review said: “Accordingly, the potential for unidentified systemic fraud at this time was high.” It added that across 2013 and 2014 the department sought to improve oversight of the provision of health services but that the department struggled to achieve this. It said the department “missed several key opportunities to address the deficiencies” as the detention population rose.

It also revealed that IHMS had no fraud risk policy in place until 2015. IHMS denies it implemented this policy after Guardian Australia’s series.

The reports found that there had been evidence of failures by IHMS to make accurate reports to the department. The final review recommended that the department include “rigorous compliance monitoring” as part of its processes.

The review found that IHMS had failed to appropriately conduct working with children checks but said “this was an ongoing issue that was never resolved”.

The reviews also made adverse findings surrounding vaccination standards and other aspects of healthcare. The department redacted all parts on the issue in its final review but disclosed an observation that read: “The level of ‘comfort’ around the provision of healthcare, or what constitutes ‘appropriate’ are ambiguous terms. From both a reputation risk perspective, and to satisfy its duty of care, the department should be assured that the provision of care, including adequate vaccinations rates, are in line with Australian community expectations.”

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Both the department and IHMS disputed that asylum seeker health had been jeopardised as a result of the failures identified.

A department spokesman said: “The department is confident that IHMS provided and continues to provide the appropriate level of healthcare to all people in immigration detention and regional processing countries.”

He added: “The review did find that there were instances of reporting errors and delays in addressing contractual compliance issues. These issues have been addressed through processes to strengthen reporting requirements from the service provider, including introducing a higher level of rigour around compliance monitoring of the immigration detention health services contract.”



He also said the department had introduced monthly performance audits to increase oversight.

An IHMS spokeswoman said: “The partial findings related to certain administrative procedures, not any deceptive or fraudulent conduct. These findings have been addressed through our strengthened reporting and compliance monitoring.

“IHMS has full confidence in the quality of the professional services we provide and is committed to open and transparent engagement with DIBP to ensure our patients receive high-quality healthcare in accordance with our contractual obligations.”

International SOS declined to provide a separate response.

The reviews also examined allegations that personal medical records of asylum seekers had been handed over by IHMS to the immigration department for “political purposes” and potentially in breach of privacy laws.

The reviews indicated they did not believe there had been a breach of Australia’s privacy laws but they contained an admission that personal data is routinely handed over to the foreign governments of Nauru and Papua New Guinea.

“The department has confirmed that it is not inappropriate for medical information to be provided to foreign governments where transfers are being made offshore, as it is necessary to provide a certain level of disclosure to the host country,” the KPMG review said.

It also disclosed that IHMS believed that it did not even need a consent form from asylum seekers to be able to hand over personal medical information to the department.

The internal review noted one instance of inappropriate access by a state office monitoring team but said it was “rapidly resolved”.

The immigration department has selectively redacted the most critical parts of the reviews.

In the areas where allegations where substantiated – such as surrounding the failure to undertake working with children checks on Christmas Island and police checks on Manus Island and deliberately misreporting incident data – the department has blocked release of information. The basis for this decision is that it would reveal trade secrets and would be considered “deliberative” material.

A department spokesman said: “Some of the redacted information details unsubstantiated allegations against IHMS. Where such allegations are not supported by evidence it would be inappropriate for the department to release them.”

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KPMG’s review was not a detailed audit of the materials or documents. It undertook some interviews and reviewed some information but the report emphasised it was not a “detailed investigation” and that it had “not comprehensively examined all available material.”

The delivery of asylum seeker healthcare and IHMS’s role in the delivery of the contract is also the subject of a sweeping audit currently being undertaken by the Australian National Audit Office. The findings are scheduled to be tabled in June 2015.

There are also several individual and class action claims against the Australian government by asylum seekers over alleged medical negligence.

Some of the allegations surrounding IHMS were also referred to the Australian federal police for investigation by the Greens senator Sarah Hanson-Young. An investigation was initiated by the AFP but was later closed.

A spokeswoman for the AFP said: “The AFP can confirm it received a referral in relation to this matter on 30 July 2015.

“The matter was accepted for investigation, however there was insufficient evidence to establish any criminal offences and the matter was finalised.”