PSR Director's Update for May 2018

14 June 2018
 
 
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 feedback@psr.gov.au.
 

In May 2018, 5 negotiated agreements came into effect and 1 final determination became effective.

A. Director’s Section 92 agreements effective in May 2018

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 Medicare Benefits Schedule (MBS) items 23, 36, 44, 721, 723, 732, 11506, 11610, 18232, 18234, 31205, 31220, 31225, 41647, 45203, 45617 and 45620 was reviewed by the Director. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $400,000, to be disqualified from providing MBS items 11610, 18232 and 18234 for 36 months, and will be reprimanded by the Director.
  • An agreement with a general practitioner. This practitioner’s rendering of MBS items 23, 35, 36, 43, 51, 597, 707, 731, 743 and 5067 was reviewed by the Director. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $500,000, to be disqualified for 24 months from providing MBS items 597, 707, 731 and 743, and will be reprimanded by the Director.
  • An agreement with a general practitioner. This practitioner’s rendering of MBS items 23, 36, 5020, 5040, 721, 723, 732, 2712, 2713 and 2715 was reviewed by the Director. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items, except for MBS items 23 and 5020, in relation to which the Director had no concerns. The practitioner agreed to repay $310,000, to be disqualified for six months from providing MBS items 2712, 2713 and 2715, and will be reprimanded by the Director.
  • An agreement with a general practitioner. This practitioner’s rendering of MBS items 23, 36, 732, 2713, 2715, 5020 and 5028 was reviewed by the Director. The Director had no concerns in relation to items 23, 36, 5020 and 5028. The practitioner acknowledged they engaged in inappropriate practice in connection with providing items 732, 2713 and 2715. The practitioner agreed to repay $35,000 and will be reprimanded by the Director.
  • An agreement with a general practitioner. This practitioner’s rendering of Medicare MBS items 23 and 36 was reviewed by the Director. The practitioner’s prescribing of Pharmaceutical Benefits Scheme items 1215Y, 2089Y, 2335X, 2622B, 3162K and 8785J was also reviewed. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $90,000 and will be reprimanded by the Director.

B. PSR Committees' final determinations effective in May 2018

One final determination became effective in May 2018.

PSR Committee No. 1004

This general practitioner was directed to be reprimanded and counselled by the Director and to repay $384,871.64 to the Commonwealth. These directions followed from a final report of a PSR Committee which concluded the practitioner engaged in inappropriate practice for services that he rendered as MBS items 597 and 599 during the review period.

The Committee’s findings relating to MBS items and 597 and 599

During the review period, MBS items 597 and 599 were items for urgent consultation services provided during after hours periods for patients who required urgent treatment. There were regulatory definitions that defined in what circumstances a patient required urgent treatment.

The practitioner provided MBS items 597 and 599 while working for an after hours deputising service.

The Committee found that for a number of services, the practitioner provided MBS item 597 and 599 services where the regulatory requirements were not met because patients did not need to be assessed or treated urgently. The Committee considered that, in the circumstances of this particular practitioner’s case, urgency was to be assessed retrospectively. That is, whether the patient required urgent assessment or treatment was to be assessed once an MBS item 597 or 599 service had been rendered by the practitioner rather than when he received a callout from the deputising service. This was particularly the case in this practitioner’s circumstances, where he found the information he was given before attending a patient to be often unreliable.

While it is not possible to give a full overview of the circumstances of each case in this publication, pertinent information for some cases that were billed as MBS items 597 or 599 and which were not found by the Committee to have required urgent assessment or treatment included:

  • A patient for whom the presenting complaint recorded was Sore throat, Cough, Sore ears, Nasal congestion’ and the examination findings were ‘Throat Ok, Chest clear, Tms ok, afebrile’.
  • A patient for whom the presenting complaint recorded was irritable, pulling left ear’ and the examination findings were ‘Throat Ok, Chest clear, right Tm ok, left ear canal blocked, afebrile’.
  • A patient for whom the presenting complaint recorded was Headache, nausea, vomiting’ and the examination findings were ‘Photophobia no cns signs no neck stiffness alert afebrile’.

The practitioner’s recordkeeping in respect of some services was also found to be inadequate by the Committee. Important and clinically relevant information was not recorded for some services. This included presenting complaints (including the severity of patient’s symptoms), history, findings on examination, bases for diagnoses, actions taken and/or follow up arrangements. For some services, the practitioner’s use of macro templates indicated the record was not an accurate reflection of what had occurred at the consultation.

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 May 2018.

E. Referrals to AHPRA

No matters were referred to AHPRA in May 2018.