Case descriptions
Agreement entered into between Director and person under review
Dr T
General practitioner
New South Wales
Medicare Australia was concerned that Dr T’s daily servicing and rendered services may have involved inappropriate practice. Medicare Australia’s statistics showed that Dr T was in the 98th percentile for rendered services, and at or above the 98th percentile for EPC and chronic disease management services. Dr T also breached the 80/20 rule by rendering 80 or more attendances on 21 days during the review period.
The Director reviewed Dr T’s medical records to determine if inappropriate practice had taken place. The examination raised little or no concerns.
In the Director’s meeting with Dr T to discuss his review findings he noted that Dr T had breached the 80/20 rule. Dr T said he had misunderstood the 80/20 rule due to an article he had read in a medical magazine. Dr T said that Medicare Australia had not advised him that he was close to breaching the 80/20 rule and therefore he was not given the opportunity to correct the situation. He further stated that he had decreased his level of servicing by 20 per cent over the previous three months.
Dr T acknowledged that he had practiced inappropriately, and was willing to enter into a negotiated agreement. Under the circumstances, the Director considered this the most appropriate action. Dr T agreed to be reprimanded by the Director.