Case descriptions
Referral to a Committee
Dr John MacPherson
General practitioner
Brookvale New South Wales
Medicare Australia’s request to review noted concerns about Dr MacPherson’s:
- volume of services and daily services
- wound repair (deep tissue)
- removal of foreign bodies from the eye
- prescribing of benzodiazepines and codeine phosphate compounds
- level A attendances
- EPC items.
During the review period Dr MacPherson rendered 16,880 services for total Medicare benefits of $488,621.20.
From the sample of medical records Dr MacPherson produced for examination, the Director considered that the prescribing of codeine phosphate with paracetamol tabs and diazepam may have been inappropriate because the clinical notes reflected little evidence of management planning for chronic conditions or of consideration being given to drug interactions. The Director was also concerned about the excessive doses of addictive medications being prescribed.
The Director believed the clinical notes about wound repair items and EPC services did not satisfy the relevant MBS item descriptors or did not appear to be medically necessary. It also appeared that Dr MacPherson would routinely initiate an MBS item 72051 service in the management of patients with simple obesity.
This matter was referred to a Professional Services Review Committee. The Committee found that Dr MacPherson engaged in inappropriate practice in connection with:
- 90 per cent of MBS item 700 services
- 90 per cent of MBS item 720 services
- 34 per cent of MBS item 23 services
- all 32 MBS item 3002952 services examined by the Committee
- all 15 MBS item 3004153 services examined by the Committee.
The Committee found that Dr MacPherson failed to satisfy the MBS requirements, failed to provide an appropriate level of clinical input, rendered services that were not medically necessary, failed to keep adequate medical records and did not perform an adequate physical examination.
The Determining Authority made a determination that Dr MacPherson be reprimanded and counselled by the Director, repay $131,958.65 of Medicare benefits, and be disqualified from provision of services in Group A14 and Group A15 for three months.
- 51 MBS item 720 is a GP care plan
- 52 MBS item 30029 is repair of a laceration involving deeper tissues
- 53 MBS item 30041 is repair of a laceration involving deeper tissue more than 7 cm long