Case descriptions
Agreement entered into between Director and person under review
Dr Z
General practitioner
New South Wales
Medicare Australia was concerned that Dr Z’s skin flap items, rendering consultations with procedures, rendering consultations in the aftercare period, and skin excision items may have involved inappropriate practice. Dr Z’s statistics showed that he was at or above the 99th percentile for flap items, at or above the 98th percentile for skin excision times and at the 85th percentile for total rendered services.
The Director reviewed Dr Z’s medical records to determine if inappropriate practice had occurred. Over half (52 per cent) of the medical records examined relating to MBS item 23 services lacked sufficient clinical detail. The Director was particularly concerned that Dr Z appeared to use skin flaps in inappropriate circumstances where, because of the size of the lesion and the area on the body the lesion was positioned, wound closure could have been achieved by direct closure. The records did not provide evidence to support use of the flap for adequate wound closure. It also appeared that Dr Z had claimed MBS item 45207,45 where lesions were removed from patients’ leg, back, chest or chin and therefore did not meet the MBS criteria.
At the Director’s meeting with Dr Z it became clear that Dr Z has a special interest in skin cancer and sports medicine and predominately works in skin cancer medicine. Dr Z could not explain why there was a difference in his records in the size for re-excision lesions compared to the histopathology reports. He said in future he would not claim skin excision items until the histology results were known.
Dr Z acknowledged that his conduct in rendering some MBS item 23 services was inappropriate.
Dr Z agreed to be reprimanded by the Director, to repay $51,513.12 in Medicare benefits and to be disqualified from provision of MBS items 45200 and 45207 for six months.
- 45 MBS item 45207 is for skin flap repairs