PSR Director's Update for April 2021
A. Director’s Section 92 agreements effective in April 2021
No agreements entered into by the Director and persons under review (in accordance with s 92 of the Act) came into effect.
B. PSR Committee final determinations
One final determination, which came into effect in March 2021, was referred to in the March case outcomes with details of this matter to be published in an upcoming case outcome publication.
The details appear below:
PSR Committee No. 1171
On 23 March 2021, a final determination came into effect regarding Dr Robert Will, consultant rheumatologist. During the period under review Dr Will worked both as a consultant rheumatologist in Victoria Park, WA and as the owner and operator of a company that provided bone densitometry scans.
The practitioner was directed to:
- be reprimanded,
- be counselled, and
- repay $947,529.82 to the Commonwealth.
The directions followed from a final report of a PSR Committee, which concluded that the practitioner engaged in inappropriate practice in connection with services provided as MBS items 110, 132, 133, 12306, 12312, 12315, 12321 and 12323.
The PSR committee reviewed two aspects of Dr Will’s practice. His work as a consultant rheumatologist and his work as the owner and operator of the company. Across both of these areas of practice a relatively large number of the reviewed services were incorrectly billed.
In relation to the services provided as a consultant rheumatologist (MBS items 110,132 and 133) the Committee found the practitioner’s records were generally brief and similar across services rather than reflecting what occurred at particular consultations. While patients were always seen, the reviewed services did not always meet the requirements of the relevant MBS item descriptor. In addition, the Committee had a serious concern that in some services the information on the PBS Authority forms did not reflect the information in the patient record, but instead contained information that was inaccurate in order to enable patient access to Commonwealth subsidised medicines, which put the integrity of the Medicare system at risk.
In relation to the bone densitometry services provided through the company, the Committee made findings of inappropriate practice on the basis that Dr Will did not provide the requisite level of clinical input from a consultant rheumatologist as he did not write, or have adequate involvement in the preparation of, the report for the relevant services. There was also a persisting lack of documented referrals for these services in circumstances where a referral was required. In addition the Committee had concerns that repeated bone densitometry scans were recommended by Dr Will in circumstances where they were not clinically indicated.
The Determining Authority’s repayment direction of $947,529.82 (in relation to Medicare benefits that were paid for the MBS item 110, 132, 133, 12306, 12312, 12315, 12321 and 12323 services) reflects the level of inappropriate practice found by the Committee.
C. Federal Court
D. Referrals to the major non-compliance (fraud) division (89A & 106N)
One matter was referred to the major non-compliance (fraud) division in April 2021.
E. Referrals to AHPRA (106XA/B)
One matter was referred to AHPRA in April 2021.