PSR Director's update for January 2023

Published date

23 February 2023

A. Director’s Section 92 agreements effective in January 2023

15 agreements entered into by the Director and persons under review (in accordance with s 92 of the Act) came into effect in January:

An agreement with a General Practitioner

During the review period, the practitioner rendered Medicare Benefits Schedule (MBS) items 585, 599, 2126, 2143, 5023, 5043, 5049 and 5063 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 36, 585, 599, 2126, 2143, 2700, 2701, 5023, 5043, 5049, 5063, 41500 and 90043, and had no concerns in relation to MBS items 585 and 599 services. The Director had concerns, in relation to the remaining items, that:

the MBS requirements were not always met, including minimum time requirements where relevant
the practitioner’s record keeping was inadequate. For example, the patient records were not sufficiently comprehensible to enable another practitioner to effectively assume care
not contain sufficient patient information to allow another practitioner to readily assume care
the practitioner’s billing of MBS item 41500 was inappropriate. The reviewed records indicated that this item was billed for foreign object removal by syringe, which is excluded by the item descriptor
the practitioner inappropriately co-billed MBS item 23 and 41500 services on some occasions

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 36, 2126, 2143, 2700, 2701, 5023, 5043, 5049, 5063, 41500 and 90043. The practitioner agreed to repay $166,500, to be disqualified from providing MBS item 2126, 2143, 2701, 5063, 41500 and 92113 services for 6 months, and will be reprimanded by the Director. The disqualification from MBS item 92213 reflects disqualification from an equivalent telehealth item.

An agreement with a Medical Practitioner

During the review period, the practitioner rendered MBS items 36, 44 and 5060 in excess of 98% of their peers. The Director reviewed this practitioner’s rendering of MBS items 36, 44 and 91810. The Director had concerns that:

MBS requirements were not always met, including minimum time requirements where relevant, and item descriptor requirements including as to taking patient history and performing an examination
the practitioner’s record keeping was inadequate. For example, several of the records appear to be reliant on shortcut text that has not been sufficiently individualised for the patient
the practitioner’s clinical input was insufficient in his management of patients to whom drugs of dependence were prescribed

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 36, 44 and 91810. The practitioner agreed to repay $132,000, to be disqualified from providing MBS items 36, 44, 91801, 91802 and 91810 services for 9 months, and will be reprimanded by the Director. The disqualification from MBS items 91801 and 91802 reflects disqualification from equivalent telehealth items.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 44, 91810 and 91811, and initiated MBS items 66596, 66839 and 71097 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 36, 44, 66596, 66716, 66839, 71097, 91809, 91810 and 91811. The Director had concerns that:

MBS requirements were not always met, including as to taking patient history, performing clinical examinations or implementing appropriate management plans
not all pathology services initiated were clinically indicated and/or the reviewed records did not always document a clinical indication for the initiation of investigations
the practitioner’s records were inadequate. For example, the reviewed records often did not contain sufficient information to reflect what occurred during the service
the practitioner did not always provide sufficient clinical input in the management of presenting complaints or prescribing medication

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 36, 44, 66596, 66716, 66839, 71097, 91809, 91810 and 91811. The practitioner agreed to repay $310,000, to be disqualified from providing MBS item 36, 91801, 91802, 91809, 91810 and 91811 services for 6 months, and will be reprimanded by the Director. The disqualification from MBS items 91801 and 91802 reflects disqualification from equivalent telehealth items.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 36, 721, 723, 2713, 2715, and 91809 in excess of 98% of their peers, and prescribed Pharmaceutical Benefits Scheme (PBS) items 1215Y, 1889K, 2622B, 3119E and 8887R in excess of 97% of their peers . The Director reviewed this practitioner’s rendering and initiating of MBS items 23, 36, 721, 723, 2713, 2715, 66596, 66833, 66839 and 91809, and prescribing of PBS items 1215Y, 1889K, 2622B, 3119E, 3162K and 8887R, and had no concerns in relation to MBS item 66839 or the PBS items. The Director had concerns in relation to the remaining items that:

MBS requirements were not always met. For example, the practitioner did not always meet minimum time requirement where relevant and did not collaborate with two other health care providers in the coordination of team care arrangements when billing MBS item 723
the practitioner’s initiation of investigations was not always clinically indicated
the practitioner’s record keeping were inadequate. For example, the records did not always explain the service billed by the practitioner
the practitioner’s clinical input was sometimes insufficient. For example, the practitioner did not arrange for appropriate safety netting and follow-up

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 36, 721, 723, 2713, 2715, 66596, 66833 and 91809. The practitioner agreed to repay $400,000, to be disqualified from providing MBS item 721, 723, 92004 and 92024 services for 12 months, to be disqualified from providing MBS items 36, 2713, 91801, 92115 and 92127 services for 6 months, and will be reprimanded by the Director. The disqualification from MBS items 92004, 92024, 91801, 92115 and 92127 reflects disqualification from equivalent telehealth items.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 5028 and 90035 in excess of 97% of their peers, and prescribed PBS items 1215Y, 2622B and 2335X in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 903, 5028, 30192, 31363, 45201, 90035 and 91809, and prescribing of PBS items 1215Y, 2089Y, 2335X and 2622B, and had no concerns in relation to MBS items 23, 903, 30192, 31363, 45201 and 91809, and PBS items 1215Y and 2089Y. The Director had concerns in relation to the remaining items that:

MBS requirements were not always met including as to taking patient history and performing clinical examinations
the practitioner failed to maintain adequate records. For example, the records were brief and lacking in important clinical information
the practitioner’s prescribing was not always clinically indicated, and the practitioner did not always appropriately manage patients on opioid medications
not all attendances on residential aged care facility patients were clinically relevant

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 5028 and 90035, and prescribing PBS Items 2335X and 2622B. The practitioner will be reprimanded by the Director.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 5028 and 90035 in excess of 97% of their peers and total and daily services disproportionately to peers. The Director reviewed this practitioner’s rendering of MBS items 23, 721, 723, 5028, 90035 and 91809, and had no concerns in relation to MBS items 23 and 91809. The Director had concerns in relation to remaining items that:

MBS requirements were not always met. For example, requirements as to taking patient history and performing clinical examinations were not always met and chronic disease management plan documents were not comprehensive plans for managing patients’ chronic conditions.
the practitioner’s record keeping was inadequate. In particular, many of the records appeared to be template based without adequate individualisation for the patients or were brief and did not explain the service billed by the practitioner

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 721, 723, 5028 and 90035. The practitioner agreed to repay $40,500, to be disqualified from providing MBS item 721 services for 12 months, and will be reprimanded by the Director.

An agreement with a Dentist

During the review period, the practitioner rendered Child Dental Benefits Schedule (CDBS) items 88011, 88121, 88111, 88161 and 88572 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of CBDS items 88011, 88012, 88022, 88111, 88114, 88121, 88161 and 88572, and had no concerns in relation to CDBS items 88022, 88111 and 88121. The Director had concerns in relation to the remaining items that:

CDBS requirements were not always met. For example, in respect of CDBS item 88114 for the removal of calculus, there was no evidence of the presence of calculus
the practitioner’s records were inadequate. For example, records were brief and did not contain sufficient clinical information to explain the service
CDBS items 88114, 88161 and 88572 services were not clinically indicated on some occasions
the practitioner did not maintain adequate supervision of Oral Health Therapists

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering CDBS items 88011, 88012, 88114, 88161 and 88572. The practitioner agreed to repay $185,000, to be disqualified from providing MBS item 88572 services for 6 months, and will be reprimanded by the Director.

An agreement with a Nurse Practitioner

During the review period, the practitioner rendered MBS items 82215, 91179 and 91180 in excess of 98% of their peers. The Director reviewed this practitioner’s rendering of MBS items 82210, 82215, 91179 and 91180. The Director had concerns that:

MBS requirements were not always met. For example, the practitioner did not always meet time requirements where relevant
the practitioner’s record keeping was inadequate, in that they did not contain sufficient detail to explain the services, and were not always created as soon as practicable after the service was rendered

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 82210, 82215, 91179 and 91180. The practitioner agreed to repay $72,000, to be disqualified from providing MBS item 91179 services for 6 months, to be disqualified from providing MBS item 82210 and 91180 services for 3 months, and will be reprimanded by the Director.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 721 and 2713, and initiated MBS items 66596 and 66833 in excess of 98% of their peers. The practitioner also prescribed PBS items 1215Y, 3162K, and 8254K disproportionately to their peers. The Director reviewed this practitioner’s rendering and initiating of MBS items 23, 36, 721, 723, 732, 2713, 5020, 5040, 66596 and 91809, and prescribing of PBS items 1215Y, 3162K and 8254K, and had no concerns in relation to PBS items 1215Y, 3162K and 8254K. The Director had concerns in relation to the remaining items that:

the MBS requirements were not always met, including minimum time requirements where relevant
the practitioner’s record keeping was inadequate. The records often did not contain sufficient information to explain the service and were not sufficiently comprehensible to enable another practitioner to effectively assume care
pathology services initiated were not always clinically indicated. For example iron studies were initiated as part of a battery of tests for screening purposes without appropriate clinical justification
the practitioner’s clinical input was sometimes insufficient. For example, in some of the reviewed CDM items it was not always clear that all relevant examinations had been performed

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS items 23, 36, 721, 723, 732, 2713, 5020, 5040, 66596 and 91809. The practitioner agreed to repay $350,000, to be disqualified from providing MBS item 721, 723, 732, 92024, 92025 and 92028 services for 4 months, and will be reprimanded by the Director. The disqualification from MBS items 92024, 92025 and 92028 reflects disqualification from equivalent telehealth items.

An agreement with a Medical Practitioner

During the review period, the practitioner rendered MBS items 721 and 723 in excess of 98% of their peers. The practitioner also rendered total and daily services and prescribed PBS items 11681T and 1215Y disproportionately to their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 36, 721, 723, 732, 2195, 2506, 5000, 91795 and 91809, and PBS items 11681T, 1215Y and 2622B, and had no persisting concerns in relation to MBS item 732, and PBS items 11681T and 1215Y. The Director had persisting concerns in relation to the remaining items that:

MBS requirements were not always met. For example, Chronic Disease Management (CDM) service documents were not comprehensive plans for managing the patients’ conditions and contained generic goals, treatment and services, with little to no personalisation for the patient
the practitioner’s record keeping was inadequate. For example, the records did not always contain sufficient information to explain the service and were not sufficiently comprehensible to enable another practitioner to effectively assume care
the practitioner’s clinical input was not always adequate. For example, there was generally no record of the practitioner discussing the risks of polypharmacy with patients who were prescribed multiple drugs of dependence

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 36, 721, 723, 2195, 2506, 5000, 91795 and 91809, and prescribing PBS Item 2622B. The practitioner agreed to repay $161,000, to be disqualified from providing MBS item 721 and 2506 services for 12 months, and will be reprimanded by the Director.

An agreement with a General Practitioner.

During the review period, the practitioner rendered MBS items 36, 2713, 91809, 91810, 92068, 92069, 92127 and 92129 in excess of 98% of their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 36, 721, 723, 732, 2713, 2715, 91809, 91810, 92068, 92069, 92127 and 92129. The Director had persisting concerns that:

MBS requirements were not always met, including minimum time requirements where relevant
the practitioner’s record keeping was inadequate. For example, the records did not contain sufficient clinical information to explain the service, and the records are not sufficiently comprehensible to enable another practitioner to effectively assume care
the practitioner’s clinical input was insufficient. For example, for MBS item 732 and 92072 services the records did not evidence that general practitioner CDM plans and team care arrangements were appropriately reviewed

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 36, 721, 723, 732, 2713, 2715, 91809, 91810, 92068, 92069, 92127 and 92129. The practitioner agreed to repay $250,000, to be disqualified from providing MBS item 732, 2713, 92115 and 92127 services for 5 months, and will be reprimanded by the Director. The disqualification from MBS item 92115 reflects disqualification from an equivalent telehealth item.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 703, 705, 721, 723, 732, 92068, and 92072 in excess of 98% of their peers, and initiated MBS items 56223, 56507, 56001, 56620, 56220, 66833, 66716, 66752 and 66839 in excess of 98% of their peers. The practitioner also prescribed PBS items 2622B, 3162K and 8254K disproportionately to their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 703, 705, 721, 723, 732, 91795, 92068 and 92072, initiation of Pathology Services Group P2 and Diagnostic Imaging Services Group I2, Subgroup 3, and prescribing of PBS items 2622B, 3162K and 8254K. The Director had concerns that

MBS requirements were not always met, including minimum time requirements and as to performing examinations or assessments
initiation of investigations and prescribing were not always clinically indicated. A number of reviewed records did not include patient histories which demonstrated the reasons for investigations or prescriptions
the practitioner’s record keeping was inadequate. For example, the records do not contain sufficient clinical information to explain the service, and the records are not sufficiently comprehensible to enable another practitioner to effectively assume care
the practitioner’s clinical input was sometimes insufficient. For example, it was not always clear whether the potential side effects of prescribed items were discussed with patients

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 703, 705, 721, 723, 732, 91795, 92068, 92072, 66752, 66833, 66839, 56001, 56220, 56223, 56507 and 56620 and prescribing PBS Items 2622B, 3162K and 8254K. The practitioner agreed to repay $310,000, to be disqualified from providing all services in respect of which an MBS benefit would be payable for 36 months, to be suspended from prescribing under the PBS for 36 months, and will be reprimanded by the Director.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 721, 723, 732 and 2717 and initiated MBS items 66596, 66716 and 66833 in excess of 99% of their peers. The Director reviewed this practitioner’s provision of MBS items 23, 36, 721, 723, 732, 2713, 2717, 5020, 5040, 66596, 66716, 66833 and 91809, and had no concerns in relation to MBS items 23, 721, 66596, 66716 and 66833. The Director had concerns in relation to the remaining items that:

MBS requirements were not always met, including as to taking a detailed patient history, performing relevant examinations and implementing a management plan the practitioner’s record keeping was inadequate. In particular, the records were often brief and occasionally appeared to be copies of previous entries
the practitioner’s clinical input was insufficient. For example, the records for CDM services did not indicate that the practitioner undertook comprehensive management or reviews of patients’ chronic conditions

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 36, 723, 732, 2713, 2717, 5020, 5040 and 91809. The practitioner agreed to repay $302,000, to be disqualified from providing MBS item 2717 and 92117 services for 9 months, to be disqualified from providing MBS item 2713, 92115 and 92127 services for 6 months, and will be reprimanded by the Director. The disqualification from MBS items 92115, 92117 and 92127 reflects disqualification from an equivalent telehealth items.

An agreement with a General Practitioner.

During the review period, the practitioner rendered MBS items 36, 2717, 5040, 30026, 30219 and 45026 in excess of 99% of their peers. The practitioner also prescribed PBS item 8254K in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 36, 2717, 5020, 5040, 30026, 30219, 45026, 91809 and 91810, and PBS item 8254K, and had no concerns in relation to MBS items 23, 5020, 45026 and 91809. The Director had concerns in relation to the remaining items that:

MBS requirements were not always met, including minimum time requirements where relevant and in billing for normal aftercare for surgical procedures
the PBS restrictions were not always met. In particular, the practitioner’s records did not always support the presence of suspected or proven resistance to amoxicillin for patients who were prescribed PBS item 8254K
the practitioner’s record keeping was inadequate. For example, some of the records consisted of templates which were not individualised for patient and included irrelevant information

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 36, 2717, 5040, 30026, 30219 and 91810 and prescribing PBS Item 8254K. The practitioner agreed to repay $178,000, to be disqualified from providing MBS item 2717, 5040, 92117 and 30219 services for 3 months, and will be reprimanded by the Director. The disqualification from MBS item 92117 reflects disqualification from an equivalent telehealth item.

An agreement with a General Practitioner.

During the review period, the practitioner rendered MBS items 23, 36 and 5040 in excess of 98% of their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 36, 721, 723, 732, 5020 and 5040, and provision of a prescribed pattern of services (the 80/20 rule). The Director had concerns that:

the practitioner rendered a prescribed pattern of services, namely 80 or more attendances over 20 or more days
MBS requirements were not always met. For example, there was often no evidence of communication with collaborating practitioners as required for team care arrangements and reviews
the practitioner’s record keeping was inadequate. The records do not contain sufficient information to explain the service and were not sufficiently comprehensible to enable another practitioner to effectively assume care

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 36, 721, 723, 732, 5020 and 5040, and the services they provided on days on which they provided 80 or more professional attendance services. The practitioner agreed to repay $920,000, to be disqualified from providing MBS item 721, 723, 732, 92024, 92025 and 92028 services for 12 months, to be disqualified from providing MBS item 36 and 91801 services for 6 months, and will be reprimanded by the Director. The disqualification from MBS items 92024, 92025 and 92028 reflects disqualification from equivalent telehealth items.

B. PSR Committee final determinations

PSRC 1291

On 6 January 2023 a final determination came into effect regarding a general practitioner. The practitioner was directed to:

be reprimanded
be counselled
repay the amount of $433, 488.52 to the Commonwealth, which represented the total benefits paid in respect of MBS items 23, 36, 18234, 18236, 30192, 30195, 30203, 45202 and 45563 in connection with which the practitioner was found to have engaged in inappropriate practice by a final report of a PSR Committee.
be fully disqualified from rendering MBS item services for a period of 18 months

In relation to the MBS item 23 services the Committee made findings on the basis of one or more of the following:

MBS requirements were not met including that there was insufficient clinical content to justify a Level B consultation
The medical record was inadequate
The practitioner’s clinical input into the service was inadequate

In relation to the MBS item 36 services the Committee made findings on the basis of one or more of the following:

MBS requirements were not met including that there was insufficient clinical content to justify an attendance of at least 20 minutes duration
The medical record was inadequate
The practitioner’s clinical input into the service was inadequate

In relation to the MBS item 18234 services the Committee made findings on the basis of one or more of the following:

MBS requirements were not met in that the service did not involve injection into the primary division of the trigeminal nerve
The medical record was inadequate

In relation to the MBS item 18236 services the Committee made findings on the basis of one or more of the following:

There was insufficient clinical indication for a nerve block which, without clinical indication, is an unnecessarily invasive procedure
The medical record was inadequate

In relation to the MBS item 30192 services the Committee made findings on the basis of one or more of the following:

The medical record was inadequate including that the lesions being treated could not be identified and the patient’s consent to the treatment was not recorded
The lack of information recorded made it impossible to assess whether the practitioner provided appropriate clinical treatment

In relation to the MBS item 30195 services the Committee made findings on the basis of one or more of the following:

The medical record was inadequate including that the size and site of lesions being treated were not recorded, the clinical indication for the treatment was not recorded and there was no record of how the patient responded to treatment
The lack of information recorded made it impossible to assess whether the practitioner provided appropriate clinical treatment

In relation to the MBS item 30203 services the Committee made findings on the basis of one or more of the following:

MBS requirements were not met including the lack of confirmation of malignancy of lesions treated
The medical record was inadequate

In relation to the MBS item 45202 services the Committee made findings on the basis of one or more of the following:

The clinical indication for the skin flap was not recorded
There was insufficient clinical indication for the skin flap in any event
The medical record was inadequate

In relation to the MBS item 45563 services the Committee made findings on the basis that the medical record was inadequate including that the reasons why a simple closure was not have sufficed were not recorded.

PSRC 1376

On 17 January 2023 a final determination came into effect regarding a general practitioner. The practitioner was directed to:

be reprimanded
be counselled
repay the amount of $70,000 to the Commonwealth, which represented approximately 65% of the benefits paid in respect of MBS items 36, 44, 2713 and 2717 in connection with which the practitioner was found to have engaged in inappropriate practice by a final report of a PSR Committee.

In relation to the MBS item 36 and 44 services the Committee made findings on the basis of one or more of the following:

MBS requirements were not met including that entries for consultations did not indicate detail of a complexity sufficient to warrant a service of at least 20 and 40 minutes’ duration respectively
The medical record was inadequate

In relation to the MBS item 2713 services the Committee made findings on the basis of one or more of the following:

MBS requirements were not met including that the including that entries for consultations did not indicate detail of a complexity sufficient to warrant a service of at least 20 minutes duration in respect of a mental disorder, including in addition to matters billed separately under MBS item 23
The practitioner’s clinical input into the service was inadequate
The medical record was inadequate

In relation to the MBS item 2717 services the Committee made findings on the basis of one or more of the following:

MBS requirements were not met including that the including that there was no record of a general practitioner mental health treatment plan, the consultation was not of sufficient complexity sufficient to involve at least 40 minutes duration in preparing such a plan, and/or there was no record of any service being provided in respect of a mental health issue
The medical record was inadequate

In relation to PBS item 1169M and 8254K prescribing the Committee also made findings on the basis of one or more of the following:

The practitioner’s clinical input into the service was inadequate.
The medical record was inadequate, including that there was no clinical indication for the prescription recorded and nor was it able to be inferred from the progress note

C. No further action decisions

No decisions to take no further action in connection with a review were made in January 2023.

D. Federal Court

One decision concerning PSR was handed down in January 2023

Norouzi v Determining Authority established by s 106Q of the Health Insurance Act 1973 (Cth) [2023] FCA 35

This case concerned a direction made by the Determining Authority (DA) in its final determination dated 5 March 2021 that Dr Norouzi repay $459,555.55 (2021 repayment direction), which reflected the total benefits paid for the MBS items for those services for which he was found to have engaged in inappropriate practice by a PSR Committee (less an amount which had been voluntarily repaid).

The matter of making a repayment direction had been remitted to the DA for reconsideration when the DA’s repayment direction in an earlier final determination dated 11 May 2020 (2020 repayment direction) was quashed by the Federal Court: Norouzi v The Director of the Professional Services Review Agency [2020] FCA 1524.

Following the remittal of the 2020 repayment direction, the DA invited Dr Norouzi make submissions concerning any repayment direction that should be made. The DA then made 2021 repayment direction, which was the same as the 2020 repayment direction.

Dr Norouzi argued that the DA:

erred by not giving a new draft determination before it issued a new final determination or opportunity to respond to its proposed directions in 2021
wrongly held that in making a direction for repayment of the total benefits it could not establish that a lesser item number could have been by Dr Nououzi and did not give adequate weight to this, and other findings made in the Committee final report, in making the repayment direction

The Court dismissed Dr Norouzi’s application. The Court held that:

In respect of Ground 1, there was in fact a draft determination which identified the terms of proposed directions to Dr Norouzi, and the first court decision did not quash that draft determination. Further, no practical injustice arose as Dr Norouzi took up all invitations to make submissions, including before the second final determination and there was no failure of procedural fairness.
In respect of Ground 2, the 2021 repayment direction was not legally unreasonable, and it is not the Court’s role to assess the merits or correctness of the DA’s factual findings (including as to whether a lesser item number could have been billed) in making that direction.

E. Referrals to the major non-compliance (fraud) division (89A & 106N)

No matters were referred to the major non-compliance (fraud) division in January 2023.

F. Referrals to AHPRA (106XA/B)

One matter was referred to AHPRA in January 2023.