Case descriptions
Agreement entered into between Director and person under review
Dr D
General practitioner
Tasmania
Medicare Australia was concerned that Dr D’s level C and level D consultations and his initiation of pathology may have been inappropriate. Medicare Australia first identified Dr D in 2003.
During the review period Dr D rendered:
- 1742 level B surgery consultations25
- 1033 level C surgery consultations
- 144 level D surgery consultations.
During the review period Dr D initiated 3522 pathology services for 363 pathology patients equalling 9.70 pathology services per pathology patient.
Dr D’s notes on level C and D consultations were difficult to read; they lacked sufficient evidence in relation to complexity levels, detailed history, examination of multiple systems and management planning. Notes examined relating to Dr D’s ordering of iron studies contained no evidence to justify the investigation; indeed, many of these patients had had a recent normal full blood count.
The Director met with Dr D to discuss the issues discovered in his medical records. Dr D acknowledged that his note taking was inadequate and agreed that his practice was driven by patient demand and that he had trouble controlling this aspect of his practice.
The Director acknowledged that Dr D was a hard working practitioner who kept up to date with his continuing medical education. However, it appeared that he did not allocate sufficient time to adequately record detailed notes.
The Director considered that the level of inappropriate practice could be satisfactorily addressed by a negotiated agreement. Dr D agreed to be reprimanded by the Director, repay $40,000 in Medicare benefits and to be disqualified from providing MBS item 36 and 44 services for two months.
- 25 A level B service is defined as a ‘professional attendance involving taking a selective history, examination of the patient with implementation of a management plan’