PSR Director's update for February 2024

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

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

An agreement with a general physician 

During the review period, the practitioner rendered MBS items 132 and 133 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 110, 116, 132 and 133, and had persisting concerns that:

• the practitioner’s record keeping was inadequate. Their clinical notes were brief, and often omitted relevant clinical information. 
• the practitioner’s records did not always reflect that they had provided sufficient clinical input to meet the respective minimum time requirements for MBS items 132 and 133
• the practitioner did not appropriately manage patients with delirium and cognitive impairment. For example, it was not always clear from the record whether they used objective measurement tools, obtained psychologist or psychiatrist input or took appropriate steps to ensure such patients had adequate support in their decision making.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 110, 116, 132 and 133. The practitioner agreed to repay $342,000, to be disqualified from providing MBS items 110 and 91824 services for 6 months and will be counselled by the Director.

An agreement with a rheumatologist

During the review period, the practitioner rendered MBS items 132 and 133 in excess of 99% of their peers. The Director reviewed this practitioner’s rendering of MBS items 132, 133 and 92431 and their prescribing of PBS item 9156X and had no persisting concerns in relation to PBS item 9156X. The Director had persisting concerns in relation to the remaining items that:

• MBS requirements, including the respective minimum time requirements, were not always met. It was also unclear whether the practitioner always provided MBS item 132 and 133 services to patients with multiple morbidities as required.
• MBS requirements were not always met for MBS items 132 and 92431 where services did not involve initial assessments of the patient and for MBS item 133 where the patient had not been billed under MBS item 132 in the preceding 12 months.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 132, 133 and 92431. The practitioner agreed to repay $275,000 and will be counselled by the Director.

B. PSR Committee final determinations

No final determinations came into effect in February 2024

C. Federal Court

Raymon v Professional Services Review Committee No 1280 [2024] FCA 49 

After 4 days of hearing, a PSR Committee proceeded to complete its investigation ‘on the papers’ rather than ‘in-person’ by providing written concerns to Dr Raymon and inviting him, over an extended period of time, to respond to those concerns in writing. The Committee proposed this method because Dr Raymon was having ‘significant difficulties’ during the hearing days. The Committee then issued its draft report, invited Dr Raymon to respond, and subsequently issued its Final Report. 

Dr Raymon challenged the Committee’s Final Report, which contained findings of inappropriate practice. While Dr Raymon practically consented to the Committee’s ‘on the papers’ approach at the time, in Court he argued that the Committee was, in fact, legally required to go ahead with in-person hearings and by not doing so, he was denied procedural fairness. 

The Court rejected the argument that the entire hearing needed to occur in person saying, ‘the process proposed by the Committee was a superior way of giving the applicant procedural fairness in the circumstances.’

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

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

E. Referrals to Ahpra (106XA/B)

2 matters were referred to Ahpra in February 2024.