Case descriptions
Agreement entered into between Director and person under review
Dr V
General practitioner
New South Wales
Medicare Australia was concerned that Dr V’s rendered services, daily attendances, and prescribing under the PBS may have involved inappropriate practice.
Dr V was a solo practitioner with a busy practice treating over 7000 patients. He rendered over 18,000 services during the review period.
The Director reviewed a sample of medical records and determined that Dr V’s management plans and medical records were inappropriate. For MBS item 23, Dr V’s records were inadequate as they were brief and lacking in clinical details and contained little evidence of history and examination. His obesity management was poor, with no evidence of recorded body mass index or weight goals. He appeared to rely only on drugs to address obesity. Dr V’s prescribing of rabeprazole only for management of ulcer disease was inappropriate as there was no evidence in the records examined that he excluded helicobacter infection.
During the review the Director meet with Dr V. Discussions revealed that Dr V never claimed level C or D consultations; he said that if a consultation warranted such a claim he only ever charged for an item 23. Dr V did not have an appointment system and he felt obliged to see all patients who presented to the practice; he worked seven days a week. Since the review Dr V had tried implementing an appointment system with limited success, as patients still dropped in and expected to be seen. Dr V said he had reduced his consultations to 50 patients per day, and was willing to make further changes. He acknowledged that his records were poor and said he would undertake to change his record keeping techniques.
Dr V showed insight into Medicare Australia’s concerns, and expressed his willingness to change. The Director found it appropriate to enter into a negotiated agreement to resolve this matter. Dr V agreed to be reprimanded by the Director and to repay $85,000 in Medicare benefits.