Case descriptions
Decision to take no further action
Mr AF
Optometrist
New South Wales
Mr AF was identified as the 3rd highest user nationally of MBS item 1091317 for the period 1 October 2003 to 30 September 2004.
Mr AF was referred to PSR because Medicare Australia was concerned about his rendered services and daily servicing.
During the review period Mr AF rendered 1403 MBS item 1091818 services and more than 20 services per day on 65 days. Mr AF was at the 99th percentile for his total services and between the 98th and 99th percentile for total patients.
The Director engaged an optometrical adviser to assist him with this matter. Medical records relating to MBS item 10900,19 1091620 and 10918 were produced and examined; the clinical notes contained relevant and adequate information.
The optometrical adviser provided a written report to the Director. It was the adviser’s opinion that a committee, if established, would not be able to make a finding of inappropriate practice in this matter.
Based on the information before him the Director resolved the matter under section 91 of the Health Insurance Act 1973.
- 17 MBS item 10913 is a professional attendance of more than 15 minutes duration … where the patient has new signs or symptoms
- 18 MBS item 10918 is a professional attendance being the second or subsequent in a course of attention
- 19 MBS item 10900 is a professional attendance of more than 15 minutes duration, being the first in a course of attention
- 20 MBS item 10916 is a professional attendance, being the first in a course of attention, of not more than 15 minutes duration