PSR Director's update for January 2021

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

In January 2021, no section 92 agreements came into effect.

B. PSR Committee final determinations

PSR Committee No. 1177

On 7 January 2021, a final determination came into effect regarding Dr Haythem Amir, general practitioner, who practised in Fairfield Heights, New South Wales, during the review period.  The practitioner was directed to:

• be reprimanded,
• be counselled,
• repay $997,384.71 to the Commonwealth, and
• be disqualified from rendering Medicare Benefit Schedule (MBS) item 36, 2713, 703, 721, 723, 5040 and 5049 services for a period of 12 months.

The directions followed from a final report of a PSR Committee, which concluded that the practitioner engaged in inappropriate practice in connection with services provided as MBS items 23, 36, 703, 721, 723, 2713, 5020, 5028, 5040, 5049 and Pharmaceutical Benefit Schedule (PBS) item 2622B. 

The Committee was concerned by Dr Amir’s standard of medical record keeping across all reviewed services. The reviewed records were often dangerously deficient in failing to record critical clinical information. The inadequate record-keeping was not an aberration that only arose on busy days, but reflected the practitioner’s usual practice. The records were not merely below the standard expected from the practitioner’s peers, but were so deficient the Committee considered they gave rise to real clinical risk to patients.

In addition, the Committee was concerned with the practitioner’s compliance with MBS requirements and the level of clinical input provided into services. The Committee found in relation to the Health Assessment, General Practitioner Management Plan (GPMP) and Team Care Arrangement (TCA) services that the documents were often unmodified templates containing incorrect information and not providing clinical benefit to the patient. The GPMPs were not comprehensive plans and the TCAs did not entail necessary collaboration with other providers. Across many of the consultation services the Committee found the services did not involve sufficient clinical content to justify the relevant time requirements.

With regards to the prescribing of oxycodone 5mg tablets the Committee was concerned this medication was prescribed to drug dependent patients without any appropriate management plan in place.

The Determining Authority’s repayment direction of $997,384.71 (being the full amount of the Medicare benefits that were paid for the MBS item 23, 36, 703, 721, 2713, 5020, 5028, 5040 and 5049 services) and the disqualification period of 12 months from MBS item 36, 2713, 703, 721, 723, 5040 and 5049 services reflects the very serious degree of inappropriate practice found by the Committee.

C. Federal Court

No decisions concerning PSR were handed down in January 2021

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

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

E. Referrals to AHPRA (106XA/B)

Two matters were referred to AHPRA in January 2021.