PSR Director's Update for July 2019

A. Director’s Section 92 agreements effective in July 2019

No section 92 agreements became effective in July 2019.

Due to the delayed timing of the July meeting of the Determining Authority, section 92 agreements ratified at this meeting do not become effective until August 2019. Details of these agreements will therefore be published in our August 2019 update.

B. PSR Committee final determinations

One final determination became effective in July 2019.

PSR Committee No. 1013

On 29 July 2019, a final determination came into effect concerning a consultant physician in respiratory and sleep medicine. The practitioner was directed to be reprimanded by the Director and directed to repay $1,186,093.05 to the Commonwealth and be disqualified for 6 months from item 12250. 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 item 12250.

The Committee’s findings for the MBS item 12250 services, in relation to which the practitioner was found to have engaged in inappropriate practice, were for the following reasons, the practitioner:

• failed to keep an adequate record and meet other legislative requirements;
• failed to meet the MBS requirements for item 12250 services;
• failed to supervise the technician and scorer adequately in the rendering of all services; and
• provided inadequate clinical input into MBS item 12250 services.

For example, the practitioner failed to meet legislative requirements in failing to ensure that the date for which the service was billed was the date that he completed the service rather than the date the investigation commenced.

The practitioner failed to adequately supervise the technicians and scorers in that:

• relevant patient history taken by the technician was often not sufficiently recorded with significant conditions, such as chronic obstructive pulmonary disease, not being recorded;
• patients were identified as having ‘blood pressure’ as a comorbidity or ‘CVS’ as a risk factor without any further information being recorded;
• patients’ medication histories were inadequate;
• patient smoking and alcohol history was rarely recorded;
• information regarding patient’s sleep position was not seen in the record;
• sleep technicians decided to proceed with an investigation either where the investigation did not appear necessary as it was unlikely the patient had a high probability of obstructive sleep apnoea, or where there was insufficient information on which to make a proper assessment of whether the investigation was necessary. Tests were routinely performed at regular intervals without evidence they would alter management;
• in a number of services deficiencies were seen in the scored data that the practitioner received from the sleep scorers. In some cases there appeared to be inconsistences in the arousal index and the recorded apnoeas, and in others the data appeared to be insufficient on which to make an assessment of the patient’s sleep stages. While the practitioner said he did raise issues with the scorers’ supervisor, there was no record in the cases reviewed by the Committee of him returning studies for further assessment. More concerning, there was no evidence that any of the practitioner’s Sleep Reports noted the inaccurate scoring or explained the effect this has had on the Sleep Report.

The practitioner failed to meet the requirements of the item descriptor in:

• not personally confirming the necessity of the investigation before it took place;
• having inadequate quality assurance procedures in place to ensure the sleep technicians and scorers were performing tasks to an appropriate standard;
• the duration of the sleep study was often less than the required 8 hours.

C. Federal Court

No decisions from the Federal Court were handed down in July 2019.

D. Referrals to the major non-compliance (fraud) division/Australian Federal Police

One matter was referred to the Australian Federal Police in July 2019.

E. Referrals to AHPRA (106XA/B)

Two matters were referred to AHPRA in July 2019.