PSR Annual Report 2007-08

• Contents
• Letter of Transmittal
• Director’s report
• Agency overview
• Report on performance
• Case descriptions
  • Decision to take no further action
    • Dr AA
      General practitioner
      Victoria
    • Dr AB
      General practitioner
      New South Wales
    • Dr AC
      General practitioner
      New South Wales
    • Dr AD
      General practitioner
      Victoria
    • Dr AE
      General practitioner/General surgeon
      Victoria
    • Mr AF
      Optometrist
      New South Wales
    • Dr AG
      General practitioner
      Queensland
  • Agreement entered into between Director and person under review
  • Referral to a Committee
• Legal cases
• Management and accountability
• Appendix 1 - Financial statements
• Appendix 2 - Freedom of information statement
• Glossary
• MBS items
• Compliance index

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Case descriptions

Decision to take no further action

Dr AD
General practitioner
Victoria

Medicare Australia was concerned that Dr AD may have practiced inappropriately in relation to initiation of pathology, diagnostic imaging and prescribing under the PBS. Dr AD was in the 99th percentile for diagnostic imaging and pathology services and in the 91st percentile for prescribing.

The Director reviewed Dr AD’s records to determine if inappropriate practice had occurred.

The Director considered records relating to MBS item 721, 723,⁹ 2710,¹⁰ 58100¹¹ and prescribing of lipid lowering drugs to be not inappropriate.

Most records relating to MBS item 23 and 36 services were considered to be not inappropriate although some records contained very limited clinical notes. In relation to MBS item 44 services, several records lacked sufficient evidence of adequate history and other clinical detail. Dr AD’s initiation of pathology items, particularly B12, folate, thyroid function and iron studies, often lacked relevant clinical indications.

In a meeting with the Director, Dr AD, a solo practitioner, stated that he had trouble finding another practitioner to join him. Dr AD works 12 hours a day to keep up with patient demand. He explained that since the review, he had changed many aspects of his practice.

He stated that he improved his record keeping and made adjustments to his computer system. He was now more careful when ordering pathology and said he avoided a ‘shotgun approach’. He further explained that he had started to implement enhanced primary care (EPC) items instead of using MBS item 44 services, and has employed a psychologist and another practitioner.

The Director considered that Dr AD was a caring conscientious doctor who would not cause concern in the future. The Director decided that the most appropriate action was to dismiss the case under section 91 of the Health Insurance Act 1973.

• ⁹ MBS item 723 is team care arrangements
• ¹⁰ MBS item 2710 is a GP mental health plan
• ¹¹ MBS item 58100 is diagnostic imaging of the lumbosacral spine

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