PSR Director's update for September 2024

A. Director’s Section 92 agreements effective in September 2024

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

An agreement with a General Practitioner. 

During the review period, the practitioner rendered MBS item 91891 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS item 91891 (level B telehealth consultation), and PBS items 1889K (amoxicillin) and 3119E (cefalexin). The Director had persisting concerns that:

• the practitioner’s record keeping was inadequate. Their records failed to adequately explain what occurred during consultations 
• the MBS requirements were not always met. For example, the practitioner did not meet the requirement of being a patient’s usual medical practitioner when providing a telehealth service 
• the practitioner did not aways provide sufficient clinical input when prescribing PBS item 3119E in failing to record relevant history and symptoms that would indicate a clinical basis for the prescription, and
• the practitioner’s prescribing was not always clinically indicated. 

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 91891 and prescribing PBS items 1889K and 3119E. The practitioner agreed to be counselled by the Director, and to repay the Commonwealth the sum of $290,000. 

An agreement with a General Practitioner. 

During the review period, the practitioner rendered MBS items 36, 44, 585, 599, 707, 721, 723, 2701, 2713 and 5063 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 23 (level B consultation), 36 (level C consultation), 44 (level D consultation), 599 (urgent  after-hours attendance during unsociable hours), 707 (health assessment lasting at least 60 minutes), 721 (GP Management Plan (GPMP)), 723 (Team Care Arrangement (TCA)), 732 (review of a GPMP or TCA), 2713 (mental health consultation lasting at least 20 minutes) and initiation of MBS items 66596 (iron studies) and 66833 (vitamin D quantification). The Director had persisting concerns that:

• the practitioner’s record keeping was inadequate. For example,  their notes were often too brief to explain what occurred during consultations and records did not always include  separate entries for each attendance by a patient
• MBS requirements were not always met, including minimum time requirements where relevant and eligibility requirements for chronic disease management items, and
• The practitioner’s initiation of pathology services was not always clinically indicated, and they were instead frequently initiated as part of a battery of screening tests.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 36, 44, 599, 707, 721, 723, 732, 2713, 66596 and 66833. The practitioner agreed to be reprimanded by the Director, to be disqualified from providing MBS item 44, 707, 721, 723, 732, 91802, 92024, 92025, 92028 services for 12 months, and to repay the Commonwealth the sum of $340,000.

An agreement with a General Practitioner. 

During the review period, the practitioner rendered MBS item 91891 and prescribed PBS items 2622B, 2355Y in excess of 99% of their peers, PBS item 2335X in excess of 98% of their peers, and rendered 30 or more telephone attendance items on each of 29 days in breach of the prescribed pattern of services ‘30/20 rule’. 

The Director reviewed this practitioner’s rendering of MBS items 23 and 91891, PBS items 2355Y (pregabalin 150mg) and 2622B (oxycodone), and the prescribed pattern of services.  The Director had persisting concerns that:

• the practitioner rendered a prescribed pattern of services and exceptional circumstances were not present on any of the 29 days 
• the practitioner’s record keeping was inadequate. For example record entries were very brief  and at times included  insufficiently personalised template wording
• MBS requirements were not always met including the minimum time requirement for MBS item 91891 , and 
• the practitioner did not provide  adequate ongoing clinical management of patients to whom he prescribed, and did not meet  PBS restrictions. 

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23 and 91891 and prescribing PBS items 2355Y and 2622B and in rendering a prescribed pattern of services. The practitioner agreed to be counselled by the Director, to be disqualified from providing any  services in respect of which an MBS benefit would be payable for 36 months, and to repay the Commonwealth the sum of $70,000.

An agreement with an Other Medical Practitioner (OMP). 

During the review period, the practitioner rendered MBS item 91891 in excess of 99% of their peers, and rendered 30 or more telephone attendance items on each of 20 days during the review period in breach of the prescribed pattern of services ‘30/20’ rule. The Director reviewed this practitioner’s rendering of MBS item 91891 and the prescribed pattern of services. The Director had persisting concerns that:

• the practitioner rendered a prescribed pattern of services and exceptional circumstances were not present on any of the 20 days, and
• MBS requirements were not always met, including the minimum time requirements 

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 91891 and in rendering a prescribed pattern of services. The practitioner agreed to be counselled by the Director and repay the Commonwealth the sum of $42,000. 

An agreement with a General Practitioner. 

During the review period, the practitioner’s rate of rendered Level C consultations and services rendered in the context of high daily services raised concern as to whether each service was clinically relevant and met all MBS requirements, including the minimum required duration.

The Director reviewed this practitioner’s rendering of MBS items 23, 36, 44, 2713, 91891 and 93625 (COVID-19 vaccine support services). The Director had persisting concerns that:

• the practitioner’s record-keeping was inadequate. The practitioner failed to note important clinical details, making it difficult to understand what occurred during consultations and enable another practitioner to effectively undertake the patient’s ongoing care in reliance on the record
• MBS requirements were not always met, including minimum time  requirements where relevant, and
• the practitioner did not provide sufficient clinical input on occasions where further exploration of presenting conditions or safety-netting was required.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 36, 44, 2713, 91891 and 93625. The practitioner agreed to be counselled by the Director, to be disqualified from providing MBS item 36, 44, 2713, 91801, 91802, 91891, 91900, 91910, 92115 and 92127 services for 12 months, and to repay the Commonwealth the sum of $430,000.

B. No further action decisions

There were no decisions to take no further action in September 2024.

C. PSR Committee final determinations

No final determinations came into effect in September 2024.

D. Federal Court

No final decisions concerning PSR were handed down in September 2024.

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

No matters were referred to the major non-compliance (fraud) division in September 2024.

F. Referrals to AHPRA (106XA/B)

No matters were referred to AHPRA in September 2024.