Case descriptions
Agreement entered into between Director and person under review
Ms Q
Optometrist
New South Wales
Medicare Australia’s concerns over Ms Q were with regard to rendered servicing – item 10916 and daily servicing. Medicare Australia’s statistics showed that Ms Q was in the 99th percentile for total patients, total services and for item 10916. From information contained in Medicare Australia’s request it became apparent that Ms Q did not provide routine slit lamp examinations.
The Director and an optometrical adviser met with Ms Q to discuss Medicare Australia’s request before deciding to seek clinical records for examination.
At the meeting Ms Q advised that she works seven days a week in two different practices. The optometrical adviser raised concerns that Ms Q does not routinely perform a slit lamp examination, saying that Ms Q would find herself at variance with her peers, as they would consider it inappropriate not to perform this test.
Furthermore, it was concluded that the number of patients Ms Q was servicing might make it difficult for her to provide adequate care to all her patients. Ms Q encouraged her patients to be reviewed every year; this would also be out of step with most optometrists, as it is common practice to have an examination every two years.
At the meeting Ms Q acknowledged that her conduct during the review period was inappropriate and indicated she would like to resolve this matter by way of a negotiated agreement. The Director considered this matter could be resolved expeditiously by entering into a negotiated agreement. Ms Q agreed to be reprimanded by the Director and to repay $40,000 in Medicare benefits.