Case descriptions
Agreement entered into between Director and person under review
Dr B
General practitioner
Rural/Remote New South Wales
Dr B is an overseas trained practitioner. After completing further studies in Australia Dr B was invited to participate in the Rural Recruitment Program in New South Wales. During the review period Dr B practised in a remote rural community in mid western New South Wales.
Dr B was referred to PSR as Medicare Australia was concerned that his rendering of level C and level D consultations and procedural items along with his initiation of pathology and his prescribing under the PBS might have constituted inappropriate practice.
During the review period Dr B rendered 464 level C and 414 level D consultations placing him at the 99th percentile for these services compared to all active vocationally registered general practitioners in Australia.
During the review period Dr B performed a wide variety and number of procedural services. Dr B’s three most commonly initiated pathology investigations were iron studies, malignancy associated antigens and thyroid function tests.
Medicare Australia was also concerned with Dr B’s prescribing of clopidogrel and lipid lowering drugs during the review period.
Dr B’s clinical records were examined. No concerns were raised about his provision of MBS item 23 services or his prescribing under the PBS during the review period. It was found however that his medical records relating to level C and D consultations did not justify the MBS item claimed. Specifically, it appeared that patients presented with minor conditions that would not have required the 20 or 40 minutes recorded for these consultations.
Records were examined in relation to Dr B’s provision of MBS item 721. No evidence could be found in the records examined that a plan had either been initiated or recorded.
The Director examined records about procedural items and considered that Dr B had mis-itemised many of these services. Records examined relating to Dr B’s initiation of iron studies and malignancy-associated antigens did not contain the clinical evidence to justify these types of investigations.
In his submission, Dr B advised that many of his patients presented with drug and alcohol problems, mental health issues, sexual and physical assault and domestic violence, and also chronic cardiac and respiratory conditions. These presentations are common in most rural and remote communities and do not excuse inappropriate practice.
Since the review period, Dr B had moved from New South Wales to practise in Victoria. Medicare Australia statistics showed that Dr B had made considerable changes to his practice profile.
Dr B acknowledged that he had engaged in inappropriate practice during the review period in his provision of MBS items 36, 44, 721 services and procedural items.
During a second interview Dr B was contrite and admitted his previous errors. Dr B had shown insight into his behaviour and current Medicare Australia statistics did show a more normal pattern of billing. In addition, Dr B was now working in a more supported practice with peers on hand at all times. He was aware that Medicare Australia would act upon any further transgressions promptly and that a second referral to PSR could result in disqualification for up to five years. A negotiated agreement was considered appropriate. Dr B agreed to be reprimanded by the Director, repay $165,000 in Medicare benefits and to be disqualified from provision of MBS item 36 and 44 services for 12 months. The repayment was substantial and would act as a deterrent to a repeat referral.