Case descriptions
Agreement entered into between Director and person under review
Dr W
Vocationally Recognised General Practitioner
New South Wales
Dr W came to Medicare Australia’s attention because of his high number of rendered services, services per patient and his prescribing under the PBS. He had a previous referral to PSR in 1997, and the Determining Authority made a final determination in 1999.
Dr W’s statistics showed that he was in the 99th percentile for rendered services, the 97th percentile for services per patient and the 99th percentile for prescribing under the PBS.
Dr W provided a sample of medical records for review. The Director noted that Dr W prescribed diazepam to a small number of patients who were long-term benzodiazepine users being treated for insomnia or chronic anxiety. While the Director considered that diazepam might not have been the best choice of drug for these conditions, Dr W’s use of this drug did reflect his peer’s usage.
The Director considered that Dr W may have engaged in inappropriate practice in his provision of some MBS item 36 and 2710 services as the recorded notes did not meet the MBS item descriptor or lacked sufficient clinical detail to explain the nature of the service provided.
The Director met with Dr W to discuss his concerns. During the meeting Dr W said he sees many nursing home patients, as many other general practitioners no longer undertake this role. Dr W is a solo practitioner working on average 60+ hours per week. He admitted that being a solo practitioner is tough and conceded he could understand why his statistics would alarm Medicare Australia. Since the review Dr W has adopted an appointment system and his practice is now more structured.
The Director considered it appropriate to enter into a negotiated agreement to resolve this matter.
Dr W acknowledged that during the review period he had failed to maintain adequate and contemporaneous medical records in connection with some MBS item 36 and 2710 services. He agreed to be reprimanded by the Director and to repay $10,000 in Medicare benefits.
As this was Dr W’s second adverse finding under the PSR Scheme, this mandated a referral to the Chairperson of the Medicare Participation Review Committees for further investigation.