PSR Director's Update for May 2021

29 June 2021

 

 

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.
For media enquiries, please contact PSR at 02 6120 9100 or feedback@psr.gov.au.
Read the Director’s policy on the naming of practitioners in PSR's Policy on the Publication of Case Outcomes

Due to the timing of the Determining Authority meeting in April, no section 92 agreements became effective in that month. Five section 92 agreements came into effect in May.

A. Director’s Section 92 agreements effective in May 2021

The following agreements entered into by the Director and persons under review (in accordance with s 92 of the Act) came into effect:

An agreement with a general practitioner.

During the review period, the practitioner rendered MBS item 43, 51, 903, 5028, 5040, 5049, 5060 and 5067 services in excess of 99 per cent of their peers. The Director had persisting concerns that:

  • MBS requirements were not always met, including minimum time requirements; and
  • the records were inadequate and not always contemporaneous.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering these items of concern. The practitioner agreed to repay $150,000, to be disqualified from providing MBS item 5040 for 12 months, and will be reprimanded by the Director.

An agreement with a general practitioner.

During the review period, the practitioner rendered MBS item 30071, 30192, 31358, 31363, 45201 and 45451 services in excess of 99 per cent of their peers. The Director reviewed the practitioner’s provision of MBS items 23, 5020, 30071, 30192, 31358, 31363, 45201 and 45451 and had persisting concerns that:

  • the records were inadequate
  • the MBS requirements were not always met
  • patient consent was not appropriately obtained and recorded
  • not all services were clinically indicated; and
  • clinical input was inadequate.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing these items of concern. The practitioner agreed to repay $480,000, to be disqualified from providing MBS item 30192 for 24 months, and will be reprimanded by the Director.

An agreement with a medical practitioner.

During the review period, the practitioner rendered MBS items 721, 723, 30064 and PBS item 3162K services in excess of 99 per cent of their peers. The Director reviewed the practitioner’s rendering of MBS items 721, 723, 732, 30064 and 66833, and PBS items 2622B, 3162K and 8644Y. The Director had persisting concerns that:

  • the MBS item requirements were not always met
  • the PBS restrictions for item 2622B were not met
  • the records were inadequate
  • clinical input was inadequate; and
  • management of patients was in some cases inadequate.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $130,000, to be disqualified from providing MBS items 721, 723 and 732 for 12 months, and will be reprimanded by the Director.

An agreement with a general practitioner.

During the review period, the practitioner rendered MBS items 721 and 723 and PBS items 2335X and 2622B in excess of 99 per cent of their peers and a volume of total MBS services highly disproportionate to their peers. 

The Director reviewed this practitioner’s rendering of MBS items 23, 36, 721 and 723, and PBS items 2335X, 2622B and 3162K. The Director had persisting concerns that:

  • the records were inadequate
  • the MBS and PBS requirements were not always met
  • the clinical input was not always adequate
  • the prescribing was not always clinically indicated; and
  • the management of patients was not always appropriate.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing these items of concern. The practitioner agreed to repay $410,000 and to be disqualified from providing MBS items 721 and 723 for 12 months, and will be reprimanded by the Director.

An agreement with a general practitioner.

During the review period, the practitioner rendered PBS items 1215Y, 1887H, 1888J, 1889K and 3119E in excess of 99 per cent of their peers and a volume of total MBS services highly disproportionate to their peers. The Director reviewed this practitioner’s rendering of MBS items 23 and 5020 and PBS items 1215Y, 1887H, 1888J, 1889K, 3119E and 3162K. The Director had persisting concerns that:

  • the records were inadequate
  • antibiotics and drugs of dependence were prescribed where not clinically indicated; and
  • drugs of dependence were prescribed without adequate clinical input into managing patients’ drug dependency.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing these items of concern. The practitioner agreed to repay $510,000, to be disqualified from providing all services in respect of which an MBS benefit would be payable for 3 months and to be suspended from prescribing under the PBS for 3 months, and will be reprimanded by the Director.

B. PSR Committee final determinations

No final determinations came into effect.

C. Federal Court

No decisions concerning PSR were handed down in May 2021.

D. Referrals to the major non-compliance (fraud) division (89A & 106N)

No matters were referred to the major non-compliance (fraud) division in May 2021.

E. Referrals to AHPRA (106XA/B)

Four matters were referred to AHPRA in May 2021.