PSR Director's Update for October 2018

27 November 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 October 2018, eleven s 92 agreements entered into between the Director and persons under review came into effect and one final determination became effective.

A. Director’s Section 92 agreements effective in October 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. The Director reviewed this practitioner’s rendering of Medicare Benefits Schedule (MBS) items 36, 44, 160, 707, 721, 723, 5040 and 5060. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $470,000, to be disqualified from providing MBS items 36, 44, 160, 707, 5040 and 5060 for 18 months, to be disqualified from providing MBS item 721 and 723 for 6 months, and will be reprimanded by the Director.
     
  • An agreement with a general practitioner. The Director reviewed this practitioner’s rendering of MBS items 23, 24, 707, 721, 723, 732 and 2715. 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 707, 721, 732 and 2715 for 12 months and will be reprimanded by the Director.
     
  • An agreement with a general practitioner. The Director reviewed this practitioner’s rendering of MBS items 23, 36, 160, 597, 703, 705, 721, 723, 732, 2712, 2713, 2715, 2717, 5043 and 73805 and provision of a prescribed pattern of services (the 80/20 rule). The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items and the services they provided on days on which they provided 80 or more professional attendance services. The practitioner agreed to repay $995,286, to be disqualified from providing all services in respect of which an MBS benefit would be payable for three months, and will be reprimanded by the Director.
     
  • An agreement with a general practitioner. The Director reviewed this practitioner’s rendering of MBS items 23 and 36 and Pharmaceutical Benefits Scheme (PBS) items 2622B, 3162K, 8118G, 8785J and 8849D. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $10,000, for their authority to prescribe pharmaceutical benefits under the National Health Act 1953 to be suspended for three years, and will be reprimanded by the Director.
     
  • An agreement with a general practitioner. The Director reviewed this practitioner’s rendering of MBS items 23, 721, 723, 732 and 5020 and PBS items 1215Y, 2335X, 3119E, 8814X, 9451K and 10018G. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items, except for PBS items 2335X, 8814X and 9451K, in relation to which the Director had no concerns. The practitioner agreed to repay $190,000 and will be reprimanded by the Director.
     
  • An agreement with a general practitioner. The Director reviewed this practitioner’s rendering of MBS items 23, 36, 721, 723, 732, 5020 and 10997 and their prescribing of PBS item 2622B. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $300,000, to be disqualified from providing MBS item 10997 for six months, and will be reprimanded by the Director.
     
  • An agreement with a general practitioner. The Director reviewed this practitioner’s rendering of MBS items 23, 36, 721, 723, 732, 2712, 2713, 2717, 5020, 5040, 66596, 66833 and 66839 and PBS item 8254K. 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 $300,000, to be disqualified from providing MBS items 721, 723, 732, 2712, 2717 and 5040 for six months, and will be reprimanded by the Director.
     
  • An agreement with a general practitioner. The Director reviewed this practitioner’s rendering of MBS items 597 and 599 and PBS item 8254K. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items, except for PBS item 8254K. The practitioner agreed to repay $105,000 and will be reprimanded by the Director.
     
  • An agreement with a medical practitioner. The Director reviewed this practitioner’s rendering of MBS item 597. The practitioner acknowledged they engaged in inappropriate practice in connection with providing this item. The practitioner agreed to repay $170,000 and will be reprimanded by the Director.
     
  • An agreement with a medical practitioner. The Director reviewed this practitioner’s rendering of MBS items 598 and 600. The practitioner acknowledged they engaged in inappropriate practice in connection with providing this items. The practitioner agreed to repay $160,000 and will be reprimanded by the Director.
     
  • An agreement with a medical practitioner. The Director reviewed this practitioner’s rendering of MBS items 598 and 600 and PBS items 8254K and 8319W. The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items. The practitioner agreed to repay $150,000 and will be reprimanded by the Director.

B. PSR Committees’ final determinations effective in October 2018

On 27 October 2018, a final determination came into effect concerning an optometrist. The optometrist was directed to be reprimanded and counselled by the Director. The optometrist was disqualified from rendering MBS items 10913 and 10914 for six months and directed to repay $57,059.01 to the Commonwealth. These directions followed from a final report of a PSR Committee, which concluded that the practitioner engaged in inappropriate practice in connection with rendering MBS items 10913 and 10914.

The Committee found that the practitioner’s recordkeeping in connection with the MBS item 10913 and 10914 services that it reviewed was, on occasion, inadequate. This occurred when, for example, history, diagnoses, follow-up arrangements or examination findings were either not recorded or not recorded in sufficient detail.

MBS item 10913 requires, amongst other things, that a patient with new signs or symptoms previously been seen at the same practice as the providing optometrist. In the Committee’s view, this meant the patient must be seen by an optometrist at the same physical practice, not at another practice within a corporate group. The Committee’s view was that failure to meet this regulatory requirement on its own and in the absence of any other conduct of concern would be considered unacceptable to the general body of optometrists. There were numerous services in the random sample of services where the patient had not been seen previously at the practitioner’s practice location.

Ascertaining whether a patient has presented with a new sign or symptom requiring a comprehensive reassessment requires access to previous ocular information. The purpose of the item is a reassessment, implying that there is some baseline from which to reassess.

In a number of cases, the Committee made adverse findings cases that patients who attended the practitioner either did not have new signs or symptoms or did not have new signs or symptoms that would have warranted a comprehensive reassessment. On several occasions, the Committee also found that the practitioner did not perform a comprehensive assessment.

In relation to MBS item 10914, this item is only to be billed for the comprehensive reassessment of progressive disorder. The Committee found on a number of occasions that the patient did not have a progressive disorder or, if they did, a comprehensive reassessment was not clinically indicated. In a number of cases, the Committee found that the practitioner had recorded a diagnosis of posterior subscapular cataract without a clinical basis for such a diagnosis. In some cases, a comprehensive examination was also not performed or the practitioner’s clinical input into service was inadequate.

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 October 2018.

E. Referrals to AHPRA

No matters were referred to AHPRA in October 2018.