Case descriptions
Agreement entered into between Director and person under review
Dr L
General practitioner
New South Wales
Medicare Australia was concerned that Dr L may have practiced inappropriately because of his high level of total rendered services, daily servicing, services per patient and after hours consultations.
Medicare Australia’s statistics indicated that Dr L was in the 97th percentile for total rendered services and after hours attendances and in the 98th percentile for services per patient.
Dr L’s records were reviewed and it was found that only one record for MBS item 1 provided evidence that the consultation had taken place. There was no recorded evidence for 5023 home visit items. It was also found that the records for items 23, 36, 44 and 504036 were brief, lacking in clinical detail, and the records did not justify long consultations.
At a meeting with the Director, Dr L said he had a very busy practice and, after five practitioners had retired from the practice, found it difficult to attract doctors to meet patient demand. Dr L believed he had to pick up the balance of work and acknowledged that he finds it hard to say ‘no’ to patients.
During the review period Dr L was working between two practice locations, undertaking home visits, nursing home visits and after hours consultations.
In a written submission to the Director, Dr L acknowledged that his record keeping did not always contain sufficient clinical information to satisfy the relevant MBS item descriptor for the service rendered and that he had begun to institute a system to improve his record keeping. Dr L understood and accepted the Director’s criticisms and listed further changes to his practice he intended to make.
The Director decided that the most appropriate way to resolve the matter was through a negotiated agreement. Dr L agreed to be reprimanded by the Director, to repay $160,000 of Medicare benefits and to be disqualified from items 36 to 51 (inclusive) for nine months.
- 36 MBS item 5040 is a level C attendance on a Sunday, public holiday or after 1 pm on a Saturday