PSR Director's Update for December 2017
Due to the nature of negotiated agreements and secrecy limitations imposed by the legislative scheme, no practitioners who have entered into s 92 agreements with the Director are named. The Director has the power to disclose the names and addresses of practitioners who are found by a Committee to have engaged in inappropriate practice and who are subject to a final determination. Read the Director’s policy on the naming of practitioners in PSR's Policy on the Publication of Case Outcomes For media enquiries, please contact PSR at 02 6120 9100 or firstname.lastname@example.org.
In December 2017, 3 negotiated agreements and 2 final determinations came into effect.
A. Director’s Section 92 agreements effective in December 2017
The following agreements entered into by the Director and persons under review (in accordance with s 92 of the Act) were ratified:
- An agreement with a general practitioner. This practitioner’s rendering of MBS items 701, 721, 723, 732, 2713, 2715, 10997 and 66623 was reviewed by the Director. The practitioner acknowledged they engaged in inappropriate practice in connection with providing MBS items 701, 721, 723 and 2715. The practitioner agreed to repay $135,000 and will be reprimanded by the Director.
- An agreement with a general practitioner. This practitioner’s rendering of MBS items 597 and 599 was reviewed by the Director. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $160,000 and will be reprimanded by the Director.
- An agreement with a consultant physician in sleep and respiratory medicine. This practitioner’s rendering of MBS items 11503 and 12203 was reviewed by the Director. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $1,200,000, to be disqualified from providing services as these items from certain locations, and will be reprimanded by the Director.
B. PSR Committees’ final determinations effective in December 2017
The Determining Authority made final determinations in respect of two general practitioners, each of which became effective in December 2017.
PSR Committee No. 981
This general practitioner was directed to be reprimanded and counselled by the Director and to repay $158,305.10 to the Commonwealth. These directions followed from a final report of a PSR Committee which concluded the practitioner engaged in inappropriate practice for services he rendered as MBS items 23, 24, 36 and 597 during the review period.
The Committee made widespread findings of inappropriate practice in connection with the practitioner’s recordkeeping. The practitioner frequently included negative examination findings in his records, including for examinations that were not performed. He acknowledged that he ticked examination finding boxes in his recordkeeping software inaccurately. The Committee considered that the records were inaccurate and misleading, and that it would be difficult for another practitioner on reviewing the clinical record to determine what had been done.
Other important clinical content such as patient histories was often not recorded. Recommendations were often generic across multiple consultation notes, such as the phrase ‘educate, advise reassure review if symptoms persist’, which appeared in many patients’ notes and was not customised for particular patients or elaborated on in any detail. Sufficient patient-specific information about observations that he found were also not documented. Management plans were often general in nature and provided little information of use relevant to the treatment provided.
Consultations often documented a number of reasons for visit, without there being elaboration on which of those issues were addressed or any other clinical information relevant to those conditions. Such progress notes were essentially undetailed lists of diagnoses.
In one case, the Committee also found that the practitioner did not personally attend patients in connection with the billing of a professional attendance service, which on its own was considered to be inappropriate practice.
A repayment direction of $158,305.10 was made by the Determining Authority.
PSR Committee No. 937
This general practitioner was directed to be reprimanded and counselled by the Director, to repay $225,000 to the Commonwealth, and to be disqualified from rendering MBS items 2713 and 2717 for 18 months. These directions followed from a final report of a PSR Committee which concluded the practitioner engaged in a prescribed pattern of services (that is, breached the 80/20 rule) and engaged in inappropriate practice for services he rendered as MBS items 721, 723, 2712, 2713, 2715 and 2717 during the review period.
The Committee’s findings in respect of the 80/20 rule was that the practitioner rendered 80 or more professional services on 29 days during the review period, and the Committee was not satisfied that exceptional circumstances existed on any of those days.
For MBS item 721, the Committee found that the services did not meet the MBS requirements for this item because the practitioner’s GP management plan did not contain some, or all, of the following:
- patients’ associated health conditions (typically, only some of the patient’s health conditions were listed or they were not listed in sufficient detail, and not with evidence of chronicity);
- customised, specific and clinical relevant management goals; and
- specific treatments (such as the medications that patients were taking).
Further, the entries in the clinical records contained insufficient information to explain the type of service provided at the services or to enable another practitioner to effectively take over patient care.
For MBS item 723, the Committee found that the practitioner failed to comply with the requirements surrounding the engagement of collaborating providers. That included because the practitioner had listed a practice nurse as a collaborating provider, to whom no responsibilities were allocated. The Committee’s view was that the nurse was undertaking tasks on the practitioner’s behalf or assisting him prepare the TCAs, rather than providing a different kind of treatment or service for the plan that might satisfy the MBS requirements. In other respects, there were numerous other deficiencies in the records relating to these services.
For MBS item 2713 (mental health care attendances), the practitioner’s note followed a similar, template-generated format, with symbols (pluses and question marks) next to diagnoses or other words. This symbol usage was found not to convey much meaningful information, and the inclusion of template items that were not used by the practitioner was confusing because it implied examinations had been conducted when that was not the case. There was no particularisation or personalisation of the template-generated content in the progress notes.
Information that might have justified prescriptions and other management that the practitioner provided were also not included in the practitioner’s records. Patient histories were very sparse, particularly where the information that was recorded was important information relating to the patient’s mental health. There were also a number of internal contradictions within the records.
The Committee found that the records for numerous MBS item 2713 consultations did not last at least 20 minutes (as required by the item descriptor) for several reasons, including because the brevity of the practitioner’s notes did not justify consultations of such a duration.
For MBS items 2712, 2715, and 2717, the Committee’s findings flowed from the practitioner’s failure to record some or all of treatment goals, actions to be taken by patients, plans for crises intervention or relapse prevention and/or review dates. The information recorded was also found to be inaccurate.
The Committee reviewed MBS items 732, 66609, and 66176, but did not find that the practitioner engaged in inappropriate practice in connection with these items.
A repayment direction of $225,000 was made by the Determining Authority.
C. Federal Court
The decision in the judicial review application first mentioned in September 2017 remains reserved.
D. Referrals to the major non-compliance (fraud) division
No matters were referred to the major non-compliance (fraud) division in December 2017.
E. Referrals to AHPRA
Two matters were referred to AHPRA in December 2017 for two practitioners whom PSR’s decision-makers considered failed to comply with professional expectations.