Case descriptions
Agreement entered into between Director and person under review
Dr I
Other medical practitioner
New South Wales
Dr I is a participant in MedicarePlus.34 Medicare Australia was concerned that Dr I’s practice profile was at variance to his peers in relation to:
- level C and D surgery consultations
- rendered services – EPC items
- services per patient
- initiation of pathology
- prescribing under the PBS – lipid modifying agents.
Dr I’s patient base of 825 was at the 19th percentile while his rendering of MBS item 36 services was at the 98th percentile when compared to his peers.
During the review period, 91 per cent of Dr I’s patients received level C or D consultations; 612 patients (74 per cent of total patients) received an EPC service, but a specialist, physician or psychiatrist reviewed only 24 per cent.
Samples of Dr I’s records were examined. The medical records were computer generated and most consultation items and prescribing were detailed and well documented. However, the medical records examined in relation to EPC services and mental health care plans lacked sufficient detail to justify implementing these plans. Many plans appeared to have been for relatively minor conditions and would not have contributed to improvements in the patient’s health.
From the records examined, it appeared that Dr I may have initiated the same battery of tests for every patient; there seemed to be no individual discrimination in his pathology initiation.
The Director met with Dr I as part of his review.
Dr I is a solo practitioner and a significant proportion of his patients are either pensioners or health card holders. Dr I advised that his care plans are computer generated and he uses his local Division of General Practice format.
Since the review he has decreased the number of care plans he provides. Dr I stated that he sees many mentally ill patients and they all have chronic and complex conditions. He feels it necessary to implement a care plan to ensure these patients have access to the services they require.
In his written submission to the Director Dr I conceded that some of his consultations might not have been fully documented. Dr I agreed he had practised inappropriately with regard to his rendering of MBS item 721 and 2710 services and his initiation of pathology.
The Director considered that Dr I’s inappropriate conduct could be satisfactorily addressed by a negotiated agreement. Dr I agreed to be reprimanded by the Director, repay $25,000 in Medicare benefits and to be disqualified from providing MBS item 721 and 2710 services for three months.
- 34 Under the MedicarePlus Program, medical practitioners who are registered with the program are deemed to be general practitioners for the purposes of the General Medical Services Table. As a result, a medical practitioner is entitled to render services ordinarily reserved for vocationally registered general practitioners (VRGPs) and attract higher benefits for their services.