PSR Director's update for August 2025

Published date

11 September 2025

A. Section 92 agreements effective in August 2025

Seven agreements entered into by the Director or an Associate Director and persons under review (in accordance with s 92 of the Act) came into effect in August 2025:

General practitioner

During the review period, the practitioner rendered the following MBS item services and prescribed the following PBS items in excess of 99% of their peers:

MBS items:

36 (professional attendance lasting at least 20 minutes)
2713 (professional attendance in relation to a mental health disorder, lasting at least 20 minutes)
5040 (afterhours attendance)
91800 (video attendance lasting under 20 minutes)
91801 (video attendance lasting at least 20 minutes)

PBS items:

1215Y and 12022R (paracetamol 500 mg + codeine phosphate hemihydrate 30 mg tablet, 20)
3162K (diazepam 5 mg tablet, 50)
8455B (tramadol hydrochloride 50 mg capsule, 20)
2527B (tramadol hydrochloride 50 mg modified release tablet, 20)

An Associate Director reviewed this practitioner’s rendering of MBS item 23, 36, 44 (professional attendance lasting at least 40 minutes), 2713, 5040 and 91801 services, and prescribing of PBS item 1215Y.

The Associate Director had persisting concerns that:

the MBS requirements were not always met, including whether the practitioner personally attended the patient, the consultation was in the afterhours period (for MBS item 5040 services), or the minimum time requirements were met
the practitioner’s clinical input into the service was not always adequate, including whether the medication prescribed was clinically indicated or that the patient’s health issues were appropriately managed
the practitioner’s record keeping was inadequate, including that there was not sufficient clinical information to adequately explain the service.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 23, 36, 44, 2713, 5040 and 91801 services, and prescribing PBS item 1215Y. The practitioner agreed to:

repay $120,000
be disqualified from providing MBS item 2713, 5040, 91801 and 91900 services for 12 months
to be reprimanded and counselled by the Associate Director.

Radiologist

During the review period, the practitioner rendered the following MBS items in excess of 99% of their peers:

18276 (paravertebral nerves, injection of anaesthetic agent)
57341 (computed tomography, in conjunction with a surgical procedure using interventional techniques)
59751 (arthrography, each joint)

The Director reviewed this practitioner’s rendering of MBS item 18276, 56627 (computed topography - scan of upper limb), 57341 and 59751 services. The Director had persisting concerns that:

for MBS item 56627, 57341 and 59751 services, the MBS requirements were not always met or services may not have been clinically necessary
the practitioner’s co‑billing of MBS items 56627, 57341 and 59751 was not always clinically justified
MBS item 18726 services were billed for injections in the glenohumeral joint, which is not consistent with the MBS item descriptor
the practitioner’s record keeping was inadequate, with some records lacking request or referral documentation or sufficient clinical information to explain the service.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 18276, 56627, 57341 and 59751. The practitioner agreed to repay $309,000, and to be counselled by the Director.

General practitioner

During the review period, the practitioner rendered the highest volume of MBS item 44 services in the review period compared to all providers who billed this item under Medicare. They also rendered the following MBS item services in excess of 99% of their peers:

36
599 (attendance in unsociable hours)
5060 (afterhours consultation lasting at least 40 minutes)
91802 (video attendance lasting at least 40 minutes)

The Director reviewed this practitioner’s rendering of MBS item 36, 44, 599, 5060 and 91802 services, and rendering of a prescribed pattern of services (80 or more relevant professional attendances on 20 or more days in a 12‑month period). The Director had persisting concerns that:

the practitioner rendered a prescribed pattern of services during the review period and exceptional circumstances did not exist on any of the 25 days on which the practitioner rendered 80 or more relevant services
many of the rendered services did not have any documentary evidence to support that the practitioner rendered a service for which Medicare benefits were paid
when there was evidence of an attendance, the MBS requirements were not met, including the minimum time requirements, services not being clinically necessary and clinically relevant tasks not being undertaken
the practitioner’s record keeping was inadequate, including where there were no records for the date of service and overall, the records did not include sufficient clinical information to explain the service.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 36, 44, 599, 5060 and 91802 and in providing services that constituted a prescribed pattern of services. The practitioner agreed to:

repay $760,000
to be disqualified from providing MBS item 36, 44, 599 and 5060 services for 12 months
to be reprimanded by the Director.

General practitioner

During the review period, the practitioner rendered the following MBS items in excess of 99% of their peers:

743 (organise and coordinate a case conference of at least 40 minutes)
5049 (afterhours attendance a RACF)
90035 (attendance at a RACF between 6 and 20 minutes)
90043 (attendance at a RACF lasting at least 20 minutes)
90051 (attendance at a RACF lasting at least 40 minutes)

An Associate Director reviewed this practitioner’s rendering of MBS item 36, 743, 90035, 90043, 90051 and 91891 services. The Associate Director had persisting concerns that:

MBS requirements were not always met, including the minimum time requirements
for the case conferences, it was not always clear that the practitioner attended with at least 2 other members, and the reviewed records did not always include relevant details such as the time, the discussion, identified outcomes and tasks
the practitioner sometimes co‑billed RACF professional attendance items with MBS item 743 where there did not appear to be any additional clinical input to support the billing of an MBS item 743 service
the practitioner’s record keeping was otherwise inadequate, including that sometimes a record for the service could not be located, and where records were located, they were often brief and did not include sufficient clinical information to explain the service.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 36, 743, 90035, 90043, 90051 and 91891. The practitioner agreed to:

repay $400,000
to be disqualified from providing MBS item 743, 90043, 90051, 91801, 91802, 91900 and 91910 services for 12 months
to be reprimanded and counselled by the Associate Director.

General practitioner

During the review period, the practitioner rendered MBS item 44 services in excess of 99% of their peers. They also rendered the third highest volume of MBS item 45201 (muscle, myocutaneous or skin flap for repair of skin lesion excision) services compared to all practitioners in Australia who rendered this item.

An Associate Director reviewed this practitioner’s rendering of MBS items 44, 31358 (malignant skin lesion, surgical excision - 6mm or more), 31363 (malignant skin lesion, surgical excision - 14mm or more), 31364 (non-malignant skin lesion, surgical excision - 14mm or more) and 45201. The Associate Director had no concerns in relation to MBS item 31358 services.

The Associate Director had persisting concerns that:

the MBS requirements were not always met, including the minimum time requirements for MBS item 44, and particularly as to the size, location or malignancy of the lesion excised for the procedural items
professional attendance items were co‑billed with procedural items where there was no apparent clinical input separate to the procedure
the practitioner’s clinical management of specimens was poor, with histology reports indicating specimens were provided in unlabelled jars
excisions may not have always been clinically indicated when the practitioner proceeded directly to surgical excision without a biopsy
the practitioner routinely prescribed prophylactic antibiotics for skin excision services without recording their clinical reasoning and treatment plan.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 44, 31363, 31364 and 45201 services. The practitioner agreed to repay $190,000 and to be counselled by the Associate Director.

Medical practitioner

During the review period, the practitioner rendered the following MBS item services, and prescribed the following PBS item in excess of 99% of their peers:

MBS items:

36
44
2713

PBS item:

3162K (diazepam tablet 5 mg, 50)

An Associate Director reviewed this practitioner’s rendering of MBS item 36, 44 and 2713 services, and prescribing of PBS item 3162K. The Associate Director had persisting concerns that:

MBS requirements were not always met, including minimum time requirements, and taking a detailed or extensive patient history
the practitioner’s clinical input was not always adequate, as often there was no record of taking history, assessment of the patient’s presenting complaint, treatment or advice
the practitioner’s prescribing was not always clinically indicated, including prescribing 3162K for long-term use
the practitioner’s record keeping was not always adequate, often being brief and illegible.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 36, 44 and 2713 services and prescribing PBS item 3162K. The practitioner agreed to:

repay $209,000
to be disqualified from providing MBS item 36, 44, 2713 services for 36 months
to be reprimanded by the Associate Director.

General practitioner

During the review period, the practitioner rendered and prescribed the following MBS and PBS items in excess of 99% of their peers:

MBS items:

24 (attendance between 6 and 20 minutes)
707 (attendance for a prolonged health assessment)
731 (GP contribution to a multidisciplinary care plan)
903 (participation by a GP in residential medication management review)
90035
90043
90051

PBS items:

2622B (oxycodone tablet 5mg, 20)
2089Y (temazepam tablet 10 mg, 25)
8866P (buprenorphine transdermal patch 10 microgram/hour, 2)

An Associate Director reviewed this practitioner’s rendering of MBS item 24, 707, 731, 903, 90035, 90043 and 90051 service, and prescribing of PBS items 2622B and 8866P. The Associate Director had no concerns in relation to MBS item 731 and 903 services. For the remaining services, the Associate Director had persisting concerns that:

the MBS requirements were not always met, including that professional attendances were not always clinically necessary, minimum time requirements were not always met, and the practitioner did not always take a clinically relevant patient history
the practitioner’s clinical input was not always adequate for health assessment services
the practitioner prescribed multiple opioids without recording clinical need or warnings given to patients
the practitioner’s record keeping was not always adequate.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 24, 707, 90035, 90043 and 90051 services, and prescribing PBS items 2622B and 8866P. The practitioner agreed to:

repay $190,000
to be reprimanded and counselled by the Associate Director.

B. No further action decisions

There were no decisions made under section 91 to take no further action in August 2025.

C. PSR Committee final determinations

There were no final determinations that took effect in August 2025.

D. Federal Court

Director, Professional Services Review v Yoong (No 2) [2025] FCAFC 106

As reported in the July 2025 case outcomes, the Full Court of the Federal Court in Director, Professional Services Review v Yoong [2025] FCAFC 95 found that the documents to be produced under the notice to produce issued by the Director were relevant to the review and likely to assist the Director in the performance of his investigative functions under Part VAA of the Health Insurance Act 1973 (Act).

Dr Yoong applied to the Federal Court to stay the operation of the orders made by the Full Federal Court. Because Dr Yoong had not produced documents under the notice to produce, having challenged the validity of the notice, he would have remained disqualified from receiving Medicare benefits under section 106ZPM of the Act. Dr Yoong applied for the stay pending the outcome of an application for special leave to appeal to the High Court.

The court granted the stay. Its reasons included that if a stay had not been granted, Dr Yoong’s application for special leave to appeal could be rendered futile, the stay maintained the status quo since there was a stay in place throughout the appeal proceedings, and it would be difficult to ameliorate the prejudice to Dr Yoong if the stay was not granted.

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

There were no matters referred to the major non-compliance (fraud) division in August 2025.

F. Referrals to AHPRA (106XA/B)

Two matters were referred to AHPRA in August 2025.