A doctor charged taxpayers $3.5 million, and another billed for the equivalent of five full-time roles in a single year, an audit of NSW’s porous payment system for contractor medicos reveals.
The NSW Auditor-General’s report, released on Thursday, warned that NSW Health’s “significant and persistent weaknesses” in its remuneration processes for 8000 visiting medical officers (VMOs) exposed it to errors and fraud.
One doctor claimed payment for working 9250 hours in 2024-2025, an impossible feat given it would be the equivalent of working 25.3 hours a day, every day of the year.
NSW spent $1.32 billion on expenses claimed by VMOs, who 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” enabled some doctors to double-dip – billing multiple local health districts for the same hours worked.
The top five billing VMOs charged between $1.6 million and $3.5 million in 2024-25, and 93 VMOs billed for the equivalent of 1.5 full-time roles.
VMO hires were largely stopgaps rather than long-term strategic planning, with little consideration for value for money, and VMO spending has increased by more than 10 per cent annually, the report said.
South Western Sydney LHD paid more than $405 million to VMOs, outspending rural and regional LHDs.
Australian Medical Association (AMA) NSW vice president Dr Fred Betros said this increasing VMO expenditure reflected rising patient demand and growing pressure on the public hospital system.
Betros said VMO determinations and related awards were “outdated and no longer fit-for-purpose”, and “the lack of oversight and the lack of governance is a major issue”.
The report also found a breakdown in “segregation of duties”, with more than $10 million paid for claims where the same individual performed both the checking and approval functions, and extensive use of “miscellaneous” claims.
NSW Health paid anaesthetist VMOs more than $300 million, the highest billing specialty overall.
Betros said this was not surprising, given that anaesthetists were essential to every surgery performed.
General practitioners were the next top-invoicing group – billing more than $172 million – amid GP shortages in the regions and Sydney’s outer suburbs.
VMO psychiatrists – deployed in large numbers after staff specialist psychiatrists resigned during a protracted dispute with the Minns government in 2025 – billed 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 prior to the invoice date, flouting NSW Health policy
NSW Health accepted the report’s recommendations, including strengthening VMO remuneration governance and establishing mandatory controls for local health districts.
A NSW Health spokesperson said its VMO expenditure supported critical clinical services that could not be delivered without them.
NSW Health was committed to improving oversight and protecting public funds, the spokesperson said, and was establishing new safeguards, including a statewide VMO compliance dashboard.
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