Case descriptions
Decision to take no further action
Dr AG
General practitioner
Queensland
Dr AG was referred to PSR as Medicare Australia held concerns about his level C and level D21 consultations and his prescribing of drugs of dependence.
During the review period Dr AG provided 612 services to 173 patients for total benefits of $41,352.70. Most services Dr AG provided were level C and D consultations, comprising 89 per cent of total surgery consultations.
The Director asked Dr AG to produce medical records relating to MBS item 36 and 44 services and the medical records of patients to whom Dr AG provided prescriptions for diazepam and temazepam.
Dr AG advised that he was longer practising and was preparing to sell his previous practice. He further advised that due to ill health he was unable to provide the medical records in the required timeframe. Dr AG was given numerous extensions of time to produce the medical records. Due to his non-compliance in producing medical records for examination, the Director advised Medicare Australia to cease all benefits payable for services Dr AG rendered.
During the review it become known that the Queensland Medical Board had suspended Dr AG from practice. The Director also received a letter from Dr AG’s psychologist advising of his current medical condition.
Based on the evidence before him, namely confirmation that Dr AG is mentally incapacitated and is currently suspended from practice by the Queensland Medical Board, the Director was satisfied that it would be impossible for a committee to conduct a proper investigation into this matter.
As a result, the Director decided that, in accordance with section 91 of the Health Insurance Act 1973, no further action would be taken in this matter.
- 21 A level C service is defined as a ‘professional attendance involving taking a detailed history, an examination of multiple systems,arranging and necessary investigations and implementing a management plan in relation to one or more problems and lasting at least 20 minutes’. A level D service is defined as a ‘professional attendance involving taking an exhaustive history, a comprehensive examination of multiple systems, arranging any necessary investigations and implementing a management plan in relation to one or more complex problems, and lasting at least 40 minutes’.