Case descriptions
Agreement entered into between Director and person under review
Dr O
General practitioner
Queensland
Dr O had previously been referred to PSR in 1996. The Determining Authority made a final determination in 1997. Dr O again came to Medicare Australia’s attention in August 2006.
Medicare Australia asked PSR to undertake a review of Dr O’s provision of services, in particular skin excision items, family servicing and prescribing of antibiotics and Cox-2 inhibitors. Medicare Australia’s statistics indicated that Dr O was in the 99th percentile for rendered services and he was in the 89th percentile for PBS prescribing.
Dr O’s records were reviewed to determine if inappropriate practice had occurred. Most of Dr O’s medical records did not raise concerns; however, the records for MBS item 36 services were found to be brief and lacking in clinical detail. Notes recorded simple presentation with no complex history or examination. The recorded notes did not support the consultation lasting more than 20 minutes.
The Director met with Dr O to discuss the review. Dr O noted that he had an increase in patient demand because other practices in the area had stopped bulk billing. Since the review, Dr O stated that he applied the criteria for an MBS item 36 service and improved his record keeping.
Dr O acknowledged that he had practiced inappropriately in relation to MBS item 36 services during the review period. He agreed to be reprimanded by the Director, to repay $20,000 in Medicare benefits and to be disqualified from provision of MBS item 36 services for three months.
As this was Dr O’s second adverse finding under the PSR Scheme this action mandated a referral to the Chairperson of the Medicare Participation Review Committees.