Case descriptions
Referral to a Committee
Dr Robert Bruce Allen
General practitioner
Donvale Victoria
Medicare Australia asked the Director to review Dr Allen’s provision of services relating to the ratio of level C to level D surgery consultations and his initiation of pathology. During the review period Dr Allen rendered 2391 services to 582 patients for a total Medicare benefit of $98,879. Dr Allen was above the 95th percentile for level D surgery consultations when compared to his peers; 23.31 per cent of his total consultations were level D surgery consultations and 29.54 per cent were level C.
During the review period Dr Allen initiated 3434 pathology services to 408 of his 582 patients for a total Medicare benefit of $82,649.95. Dr Allen’s pathology service, per pathology patient, was at the 99th percentile when compared to his peers.
Dr Allen was asked to provide medical records to the Director for examination. The records examined in relation to item 36 and 44 services revealed Dr Allen’s recording of clinical input during the consultation was deficient in detail. There was limited evidence of a history, examination or implementation of a management plan in the clinical records. Many patients appeared to have emotional, personality or psychiatric problems but there was no evidence in the notes that these problems were addressed.
It became clear from the records that Dr Allen had ordered a significant number of pathology tests for nearly every patient, for which justification was rarely apparent in the notes. It also became clear from the results available that most tests would have contributed little to patient management as the results were within normal parameters.
The matter was referred to a Professional Services Review Committee for further investigation. The Committee reported that Dr Allen had engaged in inappropriate practice in connection with 90 per cent of MBS item 36 and 44 services. Dr Allen had failed to provide an adequate level of clinical input into his services, failed to satisfy the MBS requirements for most services, on occasions ordered pathology where it was not reasonably necessary for managing the patient and failed to keep adequate medical records.
The Determining Authority made a determination that Dr Allen be reprimanded and counselled by the Director, repay $32,082.10 in Medicare Benefits, and be disqualified from provision of MBS item 36 and 44 services for three months.