Case descriptions
Agreement entered into between Director and person under review
Dr H
Medical practitioner
Queensland
Dr H works exclusively in a skin cancer clinic in Queensland. Medicare Australia referred Dr H because of concerns over his itemisation of skin flap and skin graft services, itemisation of skin excision services, cryotherapy and family servicing.
Medicare Australia’s statistics showed that Dr H’s itemisation of MBS item 30203 and itemisation of skin flap and skin graft services were above the 99th percentile. The proportion of benign to malignant excisions differed markedly from all active medical practitioners in Australia during the review period.
Dr H’s medical records were reviewed to determine whether inappropriate practice had occurred. It was considered that the medical records examined in relation to Dr H’s skin excision items would comply with the standard for an ‘adequate record’ as prescribed by regulation. The medical records examined for MBS items 53 and 5432 services lacked history and examination details. The patient summary sheet was an information questionnaire completed by the patient. The Director considered this summary sheet did not contain sufficient information to provide the patient’s complete past, family or social history. There was no record of any follow-up on clinically significant responses to questions on this sheet.
The records were difficult to assess with respect to flap surgery and free grafting, as there was little detail about the site or size of the lesion. In addition, the family servicing notes were poorly documented. It appeared that Dr H would examine families with children as young as seven for skin cancer. This was considered inappropriate.
At a meeting with the Director, Dr H provided an example of photos taken during a patient’s procedure. He also advised that he had stopped recording family history if he deemed it irrelevant to skin cancer. The Director advised that most peers would expect significant past/family history to be recorded whether it was relevant to skin cancer work or not.
In his submission to the Director, Dr H conceded the shortcomings in his recorded notes. PSR’s review of his services had alerted him to the need to record in more detail the size and location of lesions, not only for adequate patient care, but to ensure his note keeping is of the highest standard. Dr H agreed that he had practiced inappropriately during the review period.
The Director considered this matter could be resolved by a negotiated agreement. Dr H agreed to be reprimanded by the Director, to repay $51,850 in Medicare benefits and to be disqualified from MBS items 45200, 45203, 45206 and 4545133 for six months.
- 32 MBS item 53 is a standard consultation lasting up to 25 minutes; item 54 is a long consultation lasting more than 25 minutes but less than 45 minutes
- 33 MBS items 45200, 45203, 45206 and 45451 are for skin flap repairs and skin grafting