Case descriptions
Agreement entered into between Director and person under review
Dr P
General practitioner
New South Wales
Medicare Australia’s concerns about Dr P were his initiation of pathology, daily servicing and rendered services, services per patient, family servicing and prescribing of Cox-2 inhibiting drugs. Medicare Australia’s statistics indicated that Dr P was in the 95th percentile for total pathology services and in the 97th percentile for rendered services. In addition, he was in the 92nd percentile for services per patient and in the 91st percentile for prescribing under the PBS.
Samples of Dr P’s medical records were produced for the Director’s examination but poor handwriting made them difficult to assess. The clinical notes in relation to MBS item 23, 36 and 502037 services were brief, at times consisting of only single line, or two word entries with minimal or no history or details of findings on examination. There was no recording of allergies, family history or current medication. For item 11712, the Director found that 20 per cent of the records did not contain sufficient clinical information to justify this type of investigation; as well, 90 per cent of Dr P’s GP Management Plans did not satisfy the item descriptor or were considered not medically necessary for the care of the patient.
Dr P’s prescribing of meloxicam did not satisfy the item descriptor in 60 per cent of records. PBS criteria restrict the use of meloxicam to treatment of osteoarthritis; Dr P had used it for acute soft tissue injury. In many cases, pathology tests Dr P ordered did not appear to be clinically relevant.
Dr P stated in his meeting with the Director that since the review period he had moved to a new practice. As a result, his workload was greatly reduced and he was using computerised notes and taking better notes.
Dr P agreed to be reprimanded by the Director, to repay $90,000 in Medicare benefits and to be disqualified from provision of MBS item 721, 723 and 5020 services for three months.
- 37 MBS item 5020 is a professional attendance on a Sunday, public holiday or after 1 pm on a Saturday