Exclusive: Investigation exposes failings by IHMS, the company responsible for the health of asylum seekers in Australia’s care, and reveals pressures inside firm

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This article is more than 5 years old

IHMS, the healthcare giant at the heart of Australia's asylum system – explainer Read more

The company that provides healthcare for Australia’s asylum seekers in detention failed to meet medical targets, included incorrect data in reports, and admitted it was “inevitable” fraud would be committed as it tried to meet government standards, leaked documents reveal.

International Health and Medical Services (IHMS), which has received contracts from the Australian government worth more than $1.6bn, has taken an extraordinary approach, bending – and at times even breaking – official targets in its care of asylum seekers, internal briefings obtained by Guardian Australia show.



The firm, a subsidiary of the global healthcare giant International SOS, has been delivering healthcare to asylum seekers across successive Labor and Coalition governments since 2009 in one of the most politically divisive policy areas in Australia.

The firm runs medical care at the offshore detention centres in Christmas Island, Manus Island and Nauru, and at centres across the mainland in Sydney, Melbourne, Brisbane, Perth, Adelaide, Darwin and Curtin.

The findings of the investigation have for the first time put the spotlight on the largely unknown private company that manages asylum seekers’ medical services, and the extraordinary tension at the heart of IHMS between meeting clinical care standards and fulfilling its commercial objectives under its contracts with Australia’s Department of Immigration and Border Protection.



IHMS said in a response it had strict policies in place to manage fraud, had training programs in place and had not condoned fraudulent behaviour. The immigration department added that it regularly reviewed protocols for its contractors, and had strengthened the performance management framework to focus on asylum seeker health outcomes.

Leaked documents highlight that at various points in time, IHMS has tried to bring its commercial obligations more in line with clinical care objectives and they paint a picture of a fraught relationship with the department.

'Significant risks' to health of asylum seekers in firm's failure to meet targets Read more

Documents seen by Guardian Australia show:

IHMS believed that “fraud is inevitable” within its own ranks in its responses to the commercial indicators that allow the immigration department to measure its medical and clinical performance.

Working with children checks were not undertaken for staff at the Perth Immigration Detention Centre, and IHMS believed it was “likely to fail” compliance checks for working with children assessments at other centres, according to a January 2014 briefing note.

Incorrect data about incident reporting was included in monthly performance reports that could have led to financial penalties.

Asylum seekers who needed referrals to specialists and children needing vaccinations were failed multiple times by their healthcare provider at Christmas Island detention centre according to an external audit. At one point just 29% of asylum seekers were seen by a GP within three days. IHMS was warned there could be “significant consequences for the health and welfare” of people in detention. IHMS’s official response to the immigration department was to suggestion alterations to the criteria set out under its contract.

The company peridodically failed healthcare benchmarks for asylum seekers set by the immigration department, causing the company to face financial penalties.



IHMS’s care of asylum seekers is measured by the immigration department through a series of key healthcare benchmarks set out in its contract. These benchmarks require a certain level of performance that – if not met – could lead to the company incurring financial penalties known as abatements.

Meeting these contractual goals and delivering clinical care is seen as a conflict within the organisation. A September 2013 briefing note by a senior business analyst noted that – in the context of meeting particularly onerous performance thresholds – “fraud is inevitable”.

Guardian Australia can also reveal that IHMS included incorrect data in its reports to the immigration department.



While incident reports are required to be filed within a certain timeframe, the company identified in an August 2013 briefing that its system was prone to errors. These errors have been actively relied on by IHMS to meet performance thresholds. One slide in the presentation said: “Error 1: Time 1 is not being manually adjusted. That means Time 1= Time 2. IHMS’s ability to meet the threshold is largely dependent on these errors.”

Elsewhere, a report from February 2013 again mentions the input error, justifying the inclusion: “In cases where T1=T2, usually this reflects a data entry error. However, some of these entries are valid, so these reports are considered within threshold for performance measurement.”

Had the company not met these thresholds, it may have incurred financial penalties.

Asylum seeker healthcare firm's reports included wrong data – internal briefing Read more

In a response to the allegations raised a spokeswoman for IHMS said in a statement: “IHMS is aware that fraud is one among many risk factors any business faces. IHMS has in place stringent policies and procedures to identify manage and control fraud. Specifically, IHMS has a fraud and corruption control plan in place with the department.”

“IHMS staff undertake fraud and corruption awareness training and at no time has IHMS ever condoned fraudulent behaviour.

“IHMS has at all times complied with internal, external and departmental audits.

“The onshore performance management framework did not come into effect until February 2014. Although the performance management framework is a contractual requirement, IHMS had no motive to misrepresent performance reporting for financial benefit as suggested.”

A spokeswoman from the immigration department said: “The department has and continues to work with its service provider, IHMS to regularly review its reporting frameworks.”

“On 11 December 2014, the department commenced a new contract with IHMS. The new contract includes a strengthened performance management framework which includes both abatements and incentives and focuses on detainee health and service outcomes.

“The department remains committed to ensuring that it has the best available information and expertise to manage the health of those in detention, particularly children.”

According to official figures just over 3,000 asylum seekers are held in detention centres: 945 in Manus, 655 in Nauru, and 1,737 on Christmas Island and in mainland centres.

IHMS forms part of a global network of corporations that fall under the umbrella corporation International SOS, which delivers a range of health services around the world.



The company holds two main contracts for asylum seeker healthcare in Australia: it received $951m for health services from 2009 to 2014 at onshore detention centres, and a further $231m for health services on Nauru and Manus Island.



It was recently commissioned to provide another five years of services until December 2019 for onshore detention centres in a further $438m contract.