Case descriptions
Agreement entered into between Director and person under review
Dr Y
General practitioner
Queensland
Medicare Australia was concerned about Dr Y’s services per patient, level C consultations, vascular and cardiovascular MBS items, EPC items, initiation of pathology, initiation of diagnostic imaging, and rendering of MBS item 10993.41 Dr Y had a previous final determination from PSR in 2003.
Medicare Australia’s statistics showed that Dr Y was in the 99th percentile for services per patient, vascular and cardiovascular MBS items and EPC items; in the 98th percentile for initiation of pathology and the 78th percentile for initiation of diagnostic imaging; and above the 93rd percentile for MBS item 10993.
Samples of Dr Y’s medical records were produced for examination. The Director was not concerned about Dr Y’s provision of MBS item 23, 721, 723, 725, 10993, 55114, 55113 services or his prescribing of atorvastatin. It was clear from the records, however, that Dr Y used a cut and paste method for his notes on MBS item 36 services; and his notes did not meet the MBS criteria for item 70042 services. Examination of records relating to diagnostic procedures and investigation items 11506 and 1161043 revealed a lack of clinical indications recorded for these types of investigations. Dr Y initiated frequent and repeated tests when results were normal for pathology items 66515 and 66536.44
The Director met with Dr Y to discuss his concerns. Dr Y said his is not a normal practice as he specialised in cardiovascular risk management and his services had increased due to an ageing patient base. He further explained that he uses the cut and paste technique for item 36 only as a reminder and that he individualises them according to the patient. Dr Y said he was trying to ensure MBS criteria were met and that he had made continual improvements to his note taking.
The Director considered it appropriate to enter into a negotiated agreement. Dr Y agreed to be reprimanded by the Director, to repay $25,000 in Medicare benefits and to be disqualified from provision of MBS item 11610 for 18 months.
As this was Dr Y’s second finding of inappropriate practice, he was referred to the Chairperson of the Medicare Participation Review Committees for further investigation.
- 41 MBS item 10993 is an immunisation service provided by a nurse
- 42 MBS item 700 is a health assessment for a patient over 75 years of age
- 43 MBS item 11610 is measurement of ankle – waveform analysis
- 44 MBS items 66515 and 66536 are used for blood lipid levels