PSR Director's update for January and February 2025

Published date

28 March 2025

A. Section 92 agreements effective in January and February 2025

Ten agreements were entered into by the Director or an Associate Director and persons under review (under section 92 of the Act) and came into effect in January and February 2025.

Radiation oncologist

During the review period for the following MBS items, the practitioner was out of all active radiation oncologists nationally ranked:

first for items 15254 (radiation oncology – one field) and 30006 (burn dressing – more than 3% of the total body surface)
third for items 15556 (dosimetry – complexity level 1) and 15559 (dosimetry ‑ complexity level 2)
sixth for item 30003 (burn dressing – more than 1% of the total body surface.)

The Director reviewed this practitioner’s rendering of MBS items:

15254
15275 (implementation of an IMRT dosimetry plan)
15562 (dosimetry – complexity level 3)
15565 (preparation of an IMRT dosimetry plan)
15715 (treatment verification for IMRT).

The Director had no concerns in relation to MBS items 15254, 15275 and 15715. The Director had persisting concerns that the practitioner failed to meet MBS requirements, including complexity requirements for MBS item 15562 and 15565, and that this upcoding of some services resulted in significant unjustified cost to the Commonwealth.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 15562 and 15565. The practitioner agreed to repay $300,000 and will be counselled by the Director.

General practitioner

During the review period the practitioner rendered the following MBS items in excess of 99% of their peers:

193 (professional attendance - acupuncture)
721 (preparation of a GP management plan)
723 (preparation of team care arrangements)
5020 (after-hour attendance of less than 20 minutes)

The Director reviewed this practitioner’s rendering of MBS items 23 (attendance – less than 20 minutes), 36 (attendance – at least 20 minutes), 721, 723, 5020 and 91891 (phone attendance – at least 6 minutes).

The Director had no concerns in relation to MBS item 723. The Director had persisting concerns that:

MBS requirements and minimum time requirements where relevant were not always met, and chronic disease management (CDM) documentation was not always comprehensive
the practitioner’s record keeping was inadequate and insufficiently individualised to their patients
antibiotics were prescribed inappropriately.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 36, 721, 5020 and 91891. The practitioner agreed to repay $400,000, to be disqualified from providing MBS item 36, 91801 and 91900 services for 12 months, and will be reprimanded and counselled by the Director.

Psychiatrist

During the review period, the practitioner rendered the following MBS items in excess of 99% of their peers:

304 (professional attendance – 30 to 45 minutes)
328 (professional attendance – at least 75 minutes, at hospital)
348 (professional attendance – 20 to 45 minutes involving an interview of third party) (ranked eighth)
91829 (telehealth attendance – 30 to 45 minutes)
92435 (telehealth attendance – at least 45 minutes)
92436 (professional attendance – 30 to 45 minutes if the patient is being managed in accordance with a management plan).

The Director reviewed this practitioner’s rendering of MBS items 291 (professional attendance – at least 45 minutes), 296 (professional attendance – at least 45 minutes for a new patient), 304, 328, 348, 91829 and 92435.

The Director had persisting concerns that:

MBS requirements were not met, including minimum time requirements where relevant
the practitioner’s record keeping was inadequate, their handwritten notes were consistently illegible, and there were no records for some services
services were not always clinically relevant
the practitioner’s clinical management of patients was inadequate.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 291, 296, 304, 328, 348, 91829 and 92435. The practitioner agreed to repay $500,000, to be disqualified from providing MBS item 296, 328, 92435 and 92437 services for 12 months, to be disqualified from providing MBS item 304, 91829 and 91839 services for 8 months, and will be reprimanded and counselled by the Director.

General practitioner

During the review period, the practitioner rendered a total number of MBS services and services per day in excess of 99% of their peers. An Associate Director reviewed this practitioner’s rendering of MBS items 3 (professional attendance for an obvious problem), 23, 36, 721, 66596 (iron studies), 91890 (phone attendance – less than 6 minutes) and 91891.

The Associate Director had no concerns in relation to MBS items 3, 23 and 91890. The Associate Director had persisting concerns that:

MBS requirements were not always met
the practitioner’s record keeping was inadequate, and their notes often lacked sufficient information to explain the services and included short cut entries and automated templates with little or no personalisation
the practitioner did not always provide adequate clinical input
pathology and prescriptions were initiated and prescribed without clinical indication.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS items 36, 721, 66596 and 91891. The practitioner agreed to repay $34,000 and will be counselled by the Associate Director.

General practitioner

During the review period, the practitioner rendered MBS items 707 (professional attendance of more than 60 minutes) and 900 (participation in a Domiciliary Medication Management Review) in excess of 99% of their peers. The Associate Director reviewed this practitioner’s rendering of MBS items:

23
36
707
721
723
732 (review of a GP management plan or team care arrangements)
900
5028 (professional attendance – less than 20 minutes, at a residential aged care facility)
31363 (surgical excision of a malignant skin lesion)
45201 (myocutaneous muscle or skin flap).

The Associate Director had no concerns in relation to MBS item 31363. The Associate Director had persisting concerns that:

MBS requirements were not always met, including co-billing requirements for services provided in association with MBS item 45201
the practitioner provided inadequate clinical input at times, including by failing to address health complaints and failing to take current measurements of patients
the practitioner’s records were insufficient, and it was frequently unclear from their records whether the practitioner attended patients.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering items 23, 36, 707, 721, 723, 732, 900, 5028 and 45201. The practitioner agreed to:

repay $295,000
be disqualified from providing MBS item 707 services for 12 months
be disqualified from providing MBS item 721, 723, 732, 900, 92024, 92025, 92028 services for 6 months
be disqualified from providing MBS item 36, 91801, 91900 services for 3 months
be reprimanded and counselled by the Associate Director.

Anaesthetist

During the review period, the practitioner was ranked first compared with all active anaesthetists for the following MBS items:

13400 (restoration of cardiac rhythm)
17625 (pre-anaesthesia consultation – more than 45 minutes)
21942 (anaesthesia management)
22002 (anaesthesia and administration of homologous blood or bone marrow) (ranked first)
22012 (blood pressure monitoring by indwelling catheter)
22025 (high-risk intra-arterial cannulation) (ranked first)
22051 (intra-operative transoesophageal echocardiography) (ranked first)

The practitioner was additionally ranked in the top 10 compared with all active anaesthetists for the following MBS items:

17615 (pre-anaesthesia consultation – between 15 and 30 minutes) (ranked second)
21941 (anaesthesia for cardiac catheterisation) (ranked second)
22020 (central vein catheterisation by percutaneous or open exposure) (ranked fourth)
22031 (initial intrathecal or epidural injection) (ranked tenth)

The Director reviewed the practitioner’s rendering of MBS items 17615, 17625, 21941, 21942, 22002, 22012, 22025, 22051 and 25025 (emergency anaesthesia out of regular hours).

The Director had no concerns in relation to MBS items 22012 and 22025. The Director had persisting concerns that:

MBS requirements were not met, including minimum time requirements where relevant
the practitioner’s record keeping was inadequate, and their notes frequently failed to provide sufficient clinical information to explain what occurred during the service.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 17615, 17625, 21941, 21942, 22002, 22051 and 25025. The practitioner agreed to repay $200,000 and will be counselled by the Director.

General Practitioner

During the review period, the practitioner rendered and prescribed the following items in excess of 99% of their peers:

MBS item 732
PBS item 3162K (diazepam 5mg)

The Director reviewed this practitioner’s provision of MBS items 23, 36, 721, 723, 732, 66596 and 91891, and PBS item 2089Y.

The Director also reviewed the practitioner’s provision of a prescribed pattern of services (breach of the 80/20 rule). The Director had persisting concerns that:

he was not satisfied that a Committee could reasonably conclude that exceptional circumstances existed that affected the rendering or initiating of 80 or more relevant services on any of the 20 or more days
MBS requirements were not met, including minimum time requirements where relevant, and some patients were not eligible for services provided by the practitioner
the practitioner’s clinical management of patients was not always clinically appropriate, and some services were not clinically indicated
the practitioner’s record keeping was inadequate and included limited clinical detail and insufficient individualisation to patient presentations.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS items 23, 36, 721, 723, 732, 66596 and 91891, prescribing PBS item 2089Y and providing services that constituted a prescribed pattern of services. The practitioner agreed to repay $595,000, to be disqualified from providing MBS item 721, 723, 732, 91891, 92024, 92025 92028 services for 12 months, and will be reprimanded by the Director.

General practitioner

During the review period, the practitioner rendered MBS items 36, 721 and 2717 (preparation of a GP mental health treatment plan lasting at least 40 minutes) in excess of 99% of their peers. The Director reviewed the practitioner’s rendering of MBS items 23, 36, 44, 721, 723, 732, 2717 and 91891.

The Director had persisting concerns that:

MBS requirements were not always met, and the practitioner provided insufficient clinical input, including by failing to take a relevant history, perform appropriate examinations, provide appropriate advice, or meet minimum time requirements where relevant
the practitioner’s record keeping was inadequate, and their notes contained insufficient clinical detail. Identical notes were sometimes used for different patients with unrelated presentations.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 36, 44, 721, 723, 732, 2717 and 91891. The practitioner agreed to repay $510,000, to be disqualified from providing MBS item 44, 721, 723, 732, 2717, 91802, 91891, 91910, 92024, 92025, 92028 and 92117 services for 12 months, and will be reprimanded and counselled by the Director.

General practitioner

During the review period, the practitioner rendered and prescribed the following items in excess of 99% of their peers:

MBS item 23
MBS item 91894
PBS item 3162K
PBS item 2089Y
PBS item 2723H (nitrazepam 5mg)

The Director reviewed this practitioner’s rendering of MBS items 23 and 91891 and PBS items 3133X (oxazepam 30mg) and 3162K. The Director had persisting concerns that:

MBS requirements were not met, including minimum time requirements. The practitioner’s records did not reflect the level of detail expected for the services rendered
the practitioner’s records were inadequate and contained insufficient information. The practitioner’s handwriting was often illegible
drugs of addiction were prescribed to patients at high volumes over significant periods of time with inadequate management of these patients.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23 and 91891 and prescribing PBS items 3133X and 3162K. The practitioner agreed to repay $300,000 and will be reprimanded and counselled by the Director.

General practitioner

During the review period, the practitioner rendered and prescribed the following items in excess of 99% of their peers:

MBS item 91891
PBS item 1215Y (paracetamol 500mg + codeine phosphate hemihydrate 30mg)
PBS item 2363J (pregabalin 300mg)
PBS item 2622B (oxycodone hydrochloride 5mg)
PBS item 3162K

The Director reviewed this practitioner’s rendering of MBS items 23 and 91891 and prescribing of PBS items 1215Y, 2622B and 3162K. The Director also reviewed the practitioner’s provision of a prescribed pattern of services (breach of the 30/20 rule). The Director had persisting concerns that:

he was not satisfied that a Committee could reasonably conclude that exceptional circumstances existed that affected the rendering or initiating of 30 or more relevant phone services on any of the 20 or more days
MBS requirements were not met, including minimum time requirements where relevant
the practitioner’s record keeping was inadequate and did not always demonstrate sufficient clinical input
there was limited documented clinical indication for the prescribing of drugs of addiction, and the practitioner’s management of patients was inappropriate.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23 and 91891 and prescribing PBS items 1215Y, 2622B and 3162K and in providing services that constituted a prescribed pattern of services. The practitioner agreed to repay $183,000 and will be counselled by the Director.

B. Decisions to take no further action under section 91

Other medical practitioner

The Director reviewed services provided as MBS items 53, 54, 229, 230, 91891, 91893 and 66596. After reviewing the practitioner’s records and having regard to other relevant information including the practitioners current registration status the Director formed the view that no further action was required as circumstances exist that would make a proper investigation by a Committee impossible.

General practitioner

The practitioner was referred to PSR for rendering a prescribed pattern of services. They had rendered 30 or more phone attendance services on 20 or more days in a 12‑month period. After reviewing the practitioner’s records, the Director formed the view that no further action was required as there were insufficient grounds on which a Committee could reasonably find that the practitioner engaged in inappropriate practice during the review period.

C. PSR Committee final determinations

No final determinations came into effect in January or February 2025.

D. Federal Court

No final decisions concerning PSR were handed down in January or February 2025.

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

Two matters were referred to the major non-compliance (fraud) division in January and February 2025.

F. Referrals to Ahpra (sections 106XA and 106XB)

Three matters were referred to Ahpra in January and February 2025.