Case descriptions
Agreement entered into between Director and person under review
Dr C
General practitioner
New South Wales
Medicare Australia referred Dr C because it was concerned about his daily servicing and initiation of pathology, which were above the 95th percentile during the review period.
Dr C’s records were examined but his poor handwriting made interpretation difficult. Most contained incomplete health summary sheets, and those examined in relation to item 36 services were found to be brief and lacking in clinical detail. Clinical notes recorded only a limited history and in many cases examination results were not recorded.
During the review period Dr C rendered 166 ECGs. In half the records examined the notes did not clinically support the need for an ECG. Indeed, it appeared from one record examined that Dr C provided an ECG after the patient presented with abdominal pain and flatulence.
Examination of medical records relating to MBS pathology item 6659623 services revealed a lack of clinical indications recorded in the patient notes to justify this type of investigation. The patient’s presenting conditions would not have required this type of initial investigation.
A meeting with Dr C took place in which the review was discussed. Dr C displayed some insight into his behaviour during the review period, and since the Director’s review he had taken steps to improve his practice. He had curbed his ordering of inappropriate pathology and was using computer software to record his notes. Since the review Dr C had increased his level A24 consultations and decreased his rendering of level C consultations.
Dr C acknowledged the deficiencies in his practice during the review period and agreed he had practised inappropriately. The Director considered it appropriate to enter into a negotiated agreement to resolve this matter.
Dr C agreed to be reprimanded by the Director and to repay $27,000 in Medicare benefits.
Dr C’s case highlights the importance of keeping up-to-date legible clinical notes, and the importance of ordering only clinically relevant pathology.
- 23 MBS item 66596 is an iron study
- 24 A level A service is defined as a ‘professional attendance for an obvious problem characterised by the straightforward nature of the task that requires a short patient history and, if required, limited examination and management’