PSR Director's Update for September 2021

A. Director’s Section 92 agreements effective in September 2021

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

An agreement with a general practitioner

During the review period, the practitioner rendered high daily volumes of Medicare Benefits Schedule (MBS) services and prescribed Pharmaceutical Benefits Scheme (PBS) items 1215Y, 3162K and 3133X in a volume disproportionate to their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 721 and 723 services and prescribing of PBS items 1215Y, 2237R, 3133X and 3162K. The Director had no persisting concerns in respect of prescribing PBS items 2237R and 3133X. The Director had persisting concerns that:

• the MBS requirements were not always met. For example, there were not always two other health providers involved for services billed as MBS item 723
• the practitioner’s records were inadequate. For example, their records were often brief, omitting important information such as an adequate patient history
• the practitioner’s clinical input was inadequate
• not all services were clinically indicated and
• the practitioner did not always appropriately manage patients to whom they prescribed PBS items 1215Y and 3162K.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 23, 721 and 723, and prescribing PBS items 1215Y and 3162K. The practitioner agreed to repay $90,000, to be disqualified from providing MBS items 721 and 723 services for a period of 12 months, and will be reprimanded by the Director.

An agreement with a medical practitioner

During the review period, the practitioner rendered MBS items 30192 30196, 30202, 31358, 31363, 31367, 31369, 31376, 45201 and 45451 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 53, 30192, 30196, 30202, 31358, 31363, 31367, 31369, 31376, 45201 and 45451. The Director had persisting concerns that:

• the practitioner’s records were inadequate in relation to MBS item 53 services and the procedural services they performed. Records were often template driven and auto-populated and in some cases identical text was auto-generated for procedures. Records at times lacked sufficient detail to reflect adequate clinical input
• therapeutic procedures were not always clinically indicated
• the MBS requirements were not always met in relation to the skin lesion size, site or malignancy
• consent was not always adequately recorded and
• the practitioner did not always provide sufficient clinical input.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering these items of concern. The practitioner agreed to repay $180,000, to be disqualified from providing MBS items 30192, 30202 and 45201 services for a period of 6 months, and will be reprimanded by the Director.

An agreement with a nurse practitioner

During the review period, the practitioner was the highest ranked provider nationally of MBS item 82215. The Director reviewed this practitioner’s rendering of MBS item 82215. The Director had persisting concerns that:

• the MBS requirements were not always met as the clinical input and complexity of the service was not consistent with at least 40 minutes of clinical input being provided, as required by the MBS item descriptor and
• the practitioner’s records were not always adequate or contemporaneous. The practitioner’s handwritten records were extremely difficult to read and did not reflect that nursing processes were followed. In some cases no record for the date of service could be identified in the patient record.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 82215. The practitioner agreed to repay $80,000, to be disqualified from providing MBS item 82215 for a period of 12 months, and will be reprimanded by the Director.

An agreement with a general practitioner

During the review period, the practitioner rendered MBS item 30192, 45201 and 45202 services in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 30192, 45201 and 45202. The Director had persisting concerns that:

• the MBS requirements were not always met
• the practitioner’s records were inadequate. For example, the records often lacked information on any pre-operative assessment, surgical findings or whether anaesthetics were used
• the practitioner did not always obtain informed consent for therapeutic procedures or, if obtained, it was not always documented and
• the therapeutic procedures provided were not always clinically indicated.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering these items of concern. The practitioner agreed to repay $200,000, to be disqualified from providing MBS item 45201 and 45202 services for a period of 12 months, to be disqualified from providing MBS item 30192 services for a period of 9 months and will be reprimanded by the Director.

 An agreement with a general practitioner

During the review period, the practitioner rendered longer professional attendance items and Chronic Disease Management (CDM) services at variance to their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 36, 44 721, 723, 732, 5040 and 5060. The Director had persisting concerns that:

• the MBS requirements were not always met. For example, time requirements where relevant were not always met and for MBS service 723 the practitioner did not always communicate with two other healthcare providers and
• the practitioner’s records were inadequate. For example, the practitioner did not always record a detailed or extensive patient history for professional attendances where required by the relevant item descriptors.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering these items of concern. The practitioner agreed to repay $200,000, to be disqualified from providing MBS item 732 services for a period of 12 months and will be reprimanded by the Director.

An agreement with a general practitioner

During the review period, the practitioner rendered MBS items 193, 197 and 5020 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 23, 193, 197, 5020, 5040 and 91809. The Director had persisting concerns that:

• the MBS requirements were not always met, including minimum time requirements where relevant
• the practitioner’s records were inadequate and
• the practitioner’s clinical input was not always adequate. For example, where patients had a block of treatments in relation to acupuncture services, the practitioner did not appear to have performed assessments or examinations of the underlying conditions on the date of services reviewed.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering these items of concern. The practitioner agreed to repay $159,478.30 and will be reprimanded by the Director.

B. PSR Committee final determinations

PSR Committee No. 1092

On 13 September 2021 a final determination came into effect regarding Dr Anchita Karmakar, a medical practitioner who practised on the Gold Coast in Queensland. The practitioner was directed to:

• be reprimanded
• be counselled
• repay $352,553,70 to the Commonwealth and
• be disqualified from rendering:
  • MBS item 54, 585, 588, 591 and 594 services for a period of six months
  • MBS item 721, 723 and 732 services for a period of twelve months.

These directions followed from a final report of a PSR Committee, which concluded that the practitioner engaged in inappropriate practice in connection with services rendered as MBS items 54, 597, 721, 723 and 732.

The partial disqualification applies to MBS items 585, 588, 591 and 594 as from 1 March 2018 these items replaced MBS item 597 on the MBS. The disqualification will have substantially the same effect as a disqualification from MBS item 597.

In relation to MBS items 54 the Committee made findings of inappropriate practice on the basis of:

• failure to comply with MBS requirements, particularly time requirements
• failure to maintain an adequate record of the services provided.

In relation to MBS items 597 the Committee made findings of inappropriate practice on the basis of:

• failure comply with MBS requirements as services were not rendered to patients who required urgent assessment or treatment as required by the MBS item descriptor
• failure to maintain an adequate record of the services provided including antibiotic prescribing without a documented clinical indication.

In relation to Chronic Disease Management (CDM) services, the Committee’s findings of inappropriate practice were widespread.

In relation to MBS item 721, 723 and 732 services the findings were made on the basis that:

• adequate clinical input was not provided in relation to these services
• failure to comply with MBS requirements as the General Practitioner Management Plan (GPMP) and Team Care Arrangement (TCA) documents were not comprehensive management plans and did not incorporate meaningful tasks and goals for the patients
• failure to maintain an adequate record of the service as whilst the practitioner did contact collaborating providers in the TCA, there is no record that any such consultation occurred
• the TCA and TCA review documents did not list the treatments and services that the collaborating providers were to provide to the patents.

C. Federal Court

No decisions concerning PSR were handed down in September 2021.

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

No matters were referred to the major non-compliance (fraud) division in September 2021.

E. Referrals to AHPRA (106XA/B)

Two matters were referred to AHPRA in September 2021.