Case descriptions
Agreement entered into between Director and person under review
Dr ZZ
Medical practitioner
New South Wales
Dr ZZ is participating in the MedicarePlus Program qualifying him to claim VRGP items.
Medicare Australia was concerned that Dr ZZ may have practiced inappropriately because of his high rendering of MBS items 4700346 and 47633,47 and MBS item 30192. Dr ZZ’s statistics showed that for items 47003 to 47633, he was at or above the 97th percentile. He rendered item 30192 on 100 occasions to 79 patients. Dr ZZ’s total benefits were in the 98th percentile.
The Director reviewed a sample of Dr ZZ’s medical records. He considered that the records relating to MBS item 36 services reflected inadequate detail and did not justify the item claimed. He also found that one-third of item 47003 and 47633 services might have been mis-itemised.
The Director met with Dr ZZ to discuss his findings. During the review period Dr ZZ saw many patients on weekends with acute sporting injuries. He also indicated that billing might have been an administrative error although he was unable to prove it at the time because the previous practice denied him access to patient files.
Since the review period Dr ZZ has changed his practice location and has not seen any fracture or sporting injuries in his new practice; he felt this was because he was now located in a shopping centre. Dr ZZ advised that the new practice used electronic documentation and provided much more support. Included in his written submission, Dr ZZ provided samples of his current medical records, which showed considerable improvement from the clinical notes recorded during the review period.
Given Dr ZZ’s change of practice location, improvements made in his record keeping and the nature of the identified concerns the Director considered it appropriate to enter into a negotiated agreement. Dr ZZ agreed to be reprimanded by the Director and repay $40,000 in Medicare benefits.
- 46 MBS item 47003 is treatment of a dislocated clavicle
- 47 MBS item 47633 is for treatment of a fractured metatarsal