Case descriptions
Decision to take no further action
Dr AC
General practitioner
New South Wales
Dr AC was previously referred to PSR in 2001 having infringed the 80/20 deeming rule. The Determining Authority made a final determination in relation to that matter. Dr AC was reprimanded by the Director, repaid the sum of $58,839.50 in Medicare benefits and was disqualified for a period of four months.
Medicare Australia’s new concerns related to Dr AC’s rendered services – procedures and daily servicing. Dr AC was in the 78th percentile for rendered services and on or above the 97th percentile for rendered services – procedures.
The Director decided to examine a sample of medical records in relation to various MBS items including MBS item 23, 36, 5020, skin excision items and flap surgery services. The records examined raised no concerns; they were computer generated, well documented and met the MBS criteria.
In a meeting with the Director, Dr AC explained he worked for eight months of the year as a locum throughout Queensland and Western Australia and regularly attends conferences to maintain his continuing education. Dr AC advised that he would be cutting down on his current practice to pursue other interests.
The Director considered Dr AC a well-trained and experienced general practitioner.
The Director decided to take no further action in relation to this matter and dismissed the case under section 91 of the Health Insurance Act 1973.