Case descriptions
Agreement entered into between Director and person under review
Dr F
General practitioner
New South Wales
Dr F practised in a rural community during the review period. He has specialist training and holds fellowships with colleges of surgeons and physicians overseas. He has a special interest in cardiology and is involved in teaching medical students and overseas trained doctors.
Dr F was previously counselled under the PSR scheme in 1998 over the rate of services per patient and the proportion of level C and D consultations. He again came to Medicare Australia’s attention in 2004 at which time they were concerned that Dr F’s level of rendered and daily services and services per patient may have been inappropriate.
During the review period Dr F rendered 17,360 services to 2518 patients. Dr F claimed a total of $692,298.61 in Medicare benefits in this period. A sample of Dr F’s medical records was examined and found to be generally detailed and well documented.
The Director noted, however, that a small number of skin excision records and records relating to removal of foreign bodies did not contain sufficient evidence to meet the MBS item descriptor.
At a meeting with the Director, Dr F readily conceded that he might not have fully complied with the MBS item number descriptor relating to a number of services he had provided during the review period.
Given the amount of inappropriate conduct found and Dr F’s open acknowledgement of the deficiencies of some of his medical records, the Director decided it was appropriate to resolve the matter with a negotiated agreement. Dr F also indicated that he would soon be leaving general practice to take up a teaching role at a university.
Dr F agreed to be reprimanded by the Director, repay $27,000 in Medicare benefits and be disqualified from providing MBS item 30067,28 31275 and 3127729 services for 12 months.
- 28 MBS item 30067 is removal of a foreign body in muscle, tendon or other deep tissue
- 29 MBS items 31275 and 31277 relate to removal of skin cancers