PSR Director's update for July and August 2024

Published date

A. Director’s Section 92 agreements effective in July/August 2024 period

There were 17 agreements entered into by the Director and persons under review (in accordance with s 92 of the Act) that came into effect in July/August 2024:

An agreement with a Cardiologist. 

During the review period, the practitioner rendered MBS items 132 (consultant physician initial attendance, on patient with at least 2 morbidities, lasting at least 45 minutes) and 133 (subsequent consultant physician attendance) in excess of 99% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 132, 133, 11716, 55126 (transthoracic echocardiographic ultrasound) and 55141 and had no concerns in relation to MBS items 11716 and 55141. The Director had persisting concerns that:

  • the practitioner’s record keeping was inadequate as records did not include entries with sufficient clinical information to explain the service, and the record would not allow another practitioner to effectively continue care in reliance on the record 
  • the MBS requirements were not always met. For example, it was not always clear that patients had at least 2 morbidities for MBS item 132 services, or that for MBS item 133 services, the practitioner had provided an MBS item 132 in the previous 12 months 
  • some of the MBS item 55126 services were rendered by another medical practitioner. 

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 132, 133 and 55126. 

The practitioner agreed to repay $250,000, and will be reprimanded and counselled by the Director. 

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 23 (level B consultation) and 707 (health assessment lasting at least 60 minutes) in excess of 98% of their peers, and rendered 80 or more attendances on each of 66 days during the review period in breach of the prescribed pattern of services ‘80/20 rule’. 

The Director reviewed this practitioner’s rendering of MBS items 23, 707, 721 (GP Management Plan (GPMP)), 723 (Team Care Arrangement (TCA)) and 732 (review of a GPMP or TCA), and the prescribed pattern of services. The Director had persisting concerns that 

  • the practitioner rendered a prescribed pattern of services and exceptional circumstances were not present on any of the 66 days,
  • it was not always clear whether the practitioner attended to the patient personally,
  • it was not always clear that clinically relevant actions were taken as required by the item descriptor, and
  • the practitioner’s record keeping was inadequate. The practitioner’s records were frequently brief and did not sufficiently explain the services provided.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 23, 707, 721, 723 and 732 and in rendering a prescribed pattern of services. 

The practitioner agreed to be counselled by the Director, to repay the Commonwealth the sum of $525,000, and to be disqualified from providing MBS item 707, 732, 721, 92024 (telehealth GPMP), 92028 (telehealth review of GPMP or TCA) services for 12 months. 

An agreement with a Obstetrician - Gynaecologist

During the review period, the practitioner rendered MBS items 16500 and 55068 in excess of 99% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 16500 (antenatal attendance), 16522 (management of a complicated labour and birth) and 55068 (pelvic ultrasound), and had no concerns in relation to MBS item 16500 services. The Director had persisting concerns that

  • For MBS item 55068 services, patients received this service multiple times and it was not always clear that the service was necessary. Additionally, the item appeared to have been billed rather than the specific obstetric ultrasound items in order to avoid the limitations on the number of services that applies to the obstetric ultrasound items, and
  • MBS requirements were not always met. For example, for some MBS item 16522 services, one or more of a number of specified conditions were not present.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 16522 and 55068. The practitioner agreed to be counselled by the Director and repay the Commonwealth the sum of $80,000. 

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 23, 36, 2717, 10660, initiated MBS items 66596, 66833, and 66839, and prescribed PBS items 01891M, 08254K, and 08319W in excess of 98% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 23, 36 (level C consultation), and 91891 (level B telehealth consultation), and initiation of MBS items 66596 (iron studies) and 66833 (vitamin D quantification), and prescribing of PBS item 1891M (amoxycillin + clavulanic acid), and had no concerns in relation to MBS items 66596 and 66833. The Director had persisting concerns that

  • the practitioner’s record keeping was not always adequate. For example, for some services there was no record relevant to the reviewed service and, where there were record entries, these did not include sufficient clinical information to explain the service, and some telehealth service entries had details reflecting a physical examination that would not have been performed, 
  • MBS requirements were not always met, including minimum time requirements where relevant, 
  • the practitioner did not always provide appropriate clinical management of some patients for MBS 91891 services, and
  • the practitioner’s prescribing was not always within the PBS restrictions and the entry did not identify the clinical indication for the prescription.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 23, 36 and 91891 and prescribing PBS item 1891M. The practitioner agreed to be reprimanded and counselled by the Director, to be disqualified from providing MBS item 36 services for 12 months, to be disqualified from providing MBS item 91891 services for 6 months, and to repay the Commonwealth the sum of $400,000.

An agreement with a General Practitioner

During the review period, the practitioner rendered PBS items 1889K, 1887H, 8254K, 3119E, 1215Y, and 3162K in excess of 99% of their peers and rendered 30 or more telephone attendance items on each of 30 days in breach of the prescribed pattern of services ‘30/20 rule’. 

The Director reviewed this practitioner’s rendering of MBS items 91890 and 91891 (level A and level B telehealth consultations), PBS items 1215Y (paracetamol + codeine), 1889K (amoxicillin) and 3162K (diazepam) and the prescribed pattern of services. 

The Director was satisfied that a PSR Committee could reasonably find exceptional circumstances existed that affected the rendering of services on all of the days in which the practitioner rendered 30 or more telephone services and consequently the practitioner would not be considered to have engaged in inappropriate practice in the circumstances of a prescribed pattern of services.  The Director had persisting concerns that

  • the practitioner’s record keeping was not always adequate. For example, the practitioner’s records for most services were brief and did not include sufficient clinical information to explain what occurred at the service, 
  • the practitioner did not always meet the MBS requirements such as on occasions where the practitioner did not take a short patient history, and
  • the practitioner’s prescribing was not always clinically indicated and the practitioner did not always provide sufficient clinical input when prescribing.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 91890 and 91891 and prescribing PBS Items 1215Y, 1889K and 3162K. The practitioner agreed to be counselled by the Director, and to repay the Commonwealth the sum of $100,000. 

An agreement with a neurologist

During the review period, the practitioner initiated MBS items 11004 (electroencephalography – first day recording), 11005 (electroencephalography – subsequent day recording) and 11716 (Holter monitor recording) in excess of 99% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 11004, 11005 and 11716. The Director had persisting concerns that

  • MBS requirements were not always met. For example, the practitioner did not prepare reports for each instance of MBS item 11004 and 11005 services, and
  • the practitioner’s record keeping was inadequate. For MBS item 11716, the clinical indication for the services was not always clear from the record. 

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 11004, 11005 and 11716. The practitioner agreed to repay $40,000 and be counselled by the Director. 

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 36, and 91891 (level B telephone attendance), prescribed PBS items 01215Y, 02348N, and 08455B in excess of 99% of their peers, and rendered 30 or more telephone attendances on each of 21 days during the review period in breach of the prescribed pattern of services ‘30/20 rule’. 

The Director reviewed this practitioner’s rendering of MBS items 36 and 91891, PBS items 1215Y (paracetamol and codeine), 2348N (pregabalin) and 8455B (tramadol) and the prescribed pattern of services. The Director had persisting concerns that

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 36 and 91891, in providing services that constituted a prescribed pattern of services, and in prescribing PBS Items 1215Y, 2348N and 8455B.

The practitioner agreed to be reprimanded by the Director, be counselled by the Director, and to repay the Commonwealth the sum of $165,000. 

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 36 and 91891, and prescribed PBS item 2622B in excess of 99% of their peers and rendered 30 or more telephone attendances on each of 25 days during the review period in breach of the prescribed pattern of services ‘30/20 rule’.

The Director reviewed this practitioner’s rendering of MBS items 23, 36 and 91891, PBS item 2622B (oxycodone) and the prescribed pattern of services. The Director had persisting concerns that

  • the practitioner rendered a prescribed pattern of services and exceptional circumstances were not present on any of the 25 days,
  • MBS item requirements were not always met including minimum time requirements where relevant,
  • it was not always clear that the practitioner attended on the patient for  MBS item 23 and 91891 services,
  • the practitioner’s record keeping was inadequate, and
  • the practitioner’s clinical management associated with prescribing was inadequate.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 23, 36 and 91891, in providing services that constituted a prescribed pattern of services, as defined by the Act, and in prescribing PBS Items 2622B.

The practitioner agreed to be counselled by the Director, and to repay the Commonwealth the sum of $73,500.

An agreement with a Radiologist

During the review period, the practitioner rendered MBS items 104 (initial attendance by a specialist following a referral) and 105 (subsequent attendance), in excess of 99% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 104, 105, 55054 (ultrasonic cross-sectional echography in conjunction with a surgical procedure) and 57341 (computed tomography in conjunction with a surgical procedure using interventional techniques), and had no concerns in relation to MBS items 55054 and 57341. The Director had persisting concerns in relation to MBS items 104 and 105 in that

  • the practitioner did not perform a separate consultation service in each instance,
  • there was not always a clinical indication for services rendered by the practitioner,
  • the MBS requirements were not always met as there was no referral for a consultation, and
  • the practitioner’s record-keeping was inadequate in that there was no record of a consultation.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 104 and 105. The practitioner agreed to be counselled by the Director, and to repay the Commonwealth the sum of $160,000. 

An agreement with a Radiologist

During the review period, the practitioner rendered MBS item 104, 105, 57524, 57527, 57712, 57715, and 63328 in excess of 99% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 104, 105, 57341, 57527 (radiographic examination of foot and ankle, or ankle or leg, or leg and knee, or knee and femur), 57712 (radiographic examination of hip joint) and 57715 (radiographic examination of pelvic girdle) and had no concerns in relation to MBS items 57341, 57527, 57712 and 57715. The Director had persisting concerns that in rendering MBS items 104 and 105 that

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 104 and 105. The practitioner agreed to be counselled by the Director, and to repay the Commonwealth the sum of $150,000. 

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS item 91890 in excess of 99% of their peers and rendered 30 or more telephone attendances on each of 20 days during the review period in breach of the prescribed pattern of services ‘30/20 rule’. 

The Director reviewed this practitioner’s rendering of MBS items 91890 and 91891 (level A and level B telehealth consultations). The Director had persisting concerns that

  • the practitioner rendered a prescribed pattern of services and exceptional circumstances were not present on any of the 20 days,
  • It was not always clear that the practitioner attended on the patient,
  • the practitioner’s recordkeeping was inadequate. For example, the practitioner’s records were brief and did not explain the service, and
  • the practitioner did not always meet the MBS requirements including the minimum time requirement where relevant.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 91890 and 91891 and in providing services that constituted a prescribed pattern of services, as defined by the Act. The practitioner agreed to be counselled by the Director. 

An agreement with an Endocrinologist

During the review period, the practitioner rendered services MBS items 132, and 133 in excess of 99% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 110 (consultation physician initial attendance in a single course of treatment), 116 (consultation physician subsequent attendance in a single course of treatment), 132 and 133. The Director had persisting concerns that

  • MBS item requirements were not always met. For example, for MBS item 110 and 132 services there was not always a valid referral, or it was not for an initial attendance by the practitioner in a single course of treatment,
  • there was not always a clinical indication for MBS item 116 services,
  • the practitioner did not always provide adequate clinical input, and
  • the practitioner’s record keeping was inadequate. For example, for some MBS item 116 services there was no record of a service and, where there was a record of the service, the record was brief and did not explain the service.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 110, 116, 132 and 133. The practitioner agreed to be counselled by the Director, and to repay the Commonwealth $225,000. 

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS item 91891 in excess of 99% of their peers and rendered 30 or more telephone attendances on each of 20 days during the review period in breach of the prescribed pattern of services ‘30/20 rule’.

The Director reviewed this practitioner’s rendering of MBS items 23 and 91891, and PBS items 2355Y (pregabalin 150mg), 2363J (pregabalin 300mg) and 2622B (oxycodone 5mg) and the prescribed pattern of services. The Director had persisting concerns that

  • the practitioner rendered a prescribed pattern of services and exceptional circumstances were not present on any of the 20 days,
  • the practitioner’s record keeping was not always adequate,
  • the practitioner did not always meet the MBS requirements. For example, the practitioner’s records did not always reflect that clinically relevant actions were undertaken as required by the MBS item descriptor,
  • the practitioner did not always meet the PBS requirements when prescribing and the practitioner’s prescribing was not always clinically indicated, and
  • the practitioner’s clinical input was not always adequate where the practitioner did not provide appropriate clinical management when prescribing medication.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 23 and 91891, prescribing PBS Items 2355Y, 2363J and 2622B and in providing services that constituted a prescribed pattern of services as defined by the Act. 

The practitioner agreed to be counselled by the Director, to be reprimanded by the Directors, and to repay the Commonwealth the sum of $295,000.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 36, 44, 739 and 91801 in excess of 99% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 23, 36, 44 (level D consultation), 160 (attendance of at least 60 minutes on a patient in imminent danger of death), 2717 (attendance of at least 40 minutes to prepare a GP mental health treatment plan), 91800 and 91801 (level A and B telehealth attendances). The Director had persisting concerns that

  • the practitioner’s record keeping was inadequate. For example, record entries were brief and did not always explain the service,
  • the MBS requirements were not always met including minimum time requirements where relevant,
  • for MBS item 160 the notes did not reflect that the patient was in imminent danger of death, and
  • the practitioner did not always provide sufficient clinical input.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 23, 36, 44, 160, 2717, 91800 and 91801. The practitioner agreed to be counselled by the Director, be disqualified for a period of 12 months from the provision of MBS items 44, 91802, and 91910, and repay to the Commonwealth the sum of $270,000.

An agreement with a Nurse Practitioner

During the review period, the practitioner rendered services for MBS items 82215 (nurse practitioner attendance lasting at least 40 minutes) and 91190 (telephone attendance lasting at least 20 minutes) in excess of 98% of their peers. 

The Director reviewed this practitioner’s rendering of MBS items 82215 and 91190. The Director had persisting concerns that:

  • MBS requirements were not always met including time requirements, 
  • the practitioner’s records were inadequate. For example, at times the practitioner used template entries that were not sufficiently individualised for the patient, and
  • there was not always a clinical indication for medication prescribed or it was not reflected adequately in the notes.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 82215 and 91190. 

The practitioner agreed to be reprimanded and counselled by the Director, to be disqualified for a period of 12 months from the provision of MBS items 82215, 91180 and 91191, and to repay to the Commonwealth the sum of $45,000.00. 

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS items 23, 721, 723, 732 and 10997 and initiated MBS items 56507, 57341 and 66833 in excess of 99% of peers. 

The Director reviewed this practitioner’s rendering of MBS items 23, 721 (preparation of a general practitioner management plan (GPMP) for chronic disease), 723 (preparation of a team care arrangement (TCA) for chronic disease), 732 (review of a GPMP or TCA), 5020 (level B consultation afterhours), 10997 (service provided by a nurse or Aboriginal and Torres Strait Islander health practitioner consistent with a GPMP, TCA or multidisciplinary care plan) and initiation of MBS items 56507 (CT upper abdomen with IV contrast medium), 57341 (CT in conjunction with a surgical procedure using intervention techniques) and 66833 (vitamin D quantification), and had no concerns in relation to MBS items 23, 5020 and 10997. The Director had persisting concerns that:

  • the practitioner initiated diagnostic imaging services which were not always clinically indicated,
  • MBS requirements were not always met. For example, some patients for whom MBS item 723 services were provided did not have a chronic disease and not all MBS 721 services involved a comprehensive plan for the management of a chronic disease,  
  • the practitioner’s clinical input was not always sufficient. For example, not all MBS item 732 services involved sufficient assessment by way of review of a general practitioner management plan or team care arrangements, and
  • the practitioner’s clinical records were inadequate, 

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 721, 723, 732, 56507, 57341 and 66833. 

The practitioner agreed to be counselled by the Director, be disqualified for a period of 12 months from the provision of MBS items 732 and 92028, and repay to the Commonwealth the sum of $210,000.

An agreement with a General Practitioner

During the review period, the practitioner rendered MBS item 3 in excess of 99% of their peers and rendered 80 or more attendances on each of 34 days during the review period in breach of the prescribed pattern of services ‘80/20 rule’. 

The Director reviewed this practitioner’s rendering of MBS items 3 (level A consultation) and 5000 (level A consultation afterhours), and provision of a prescribed pattern of services. The Director had persisting concerns that the practitioner had rendered MBS items 3 and 5000 without providing a personal attendance. 

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Items 3 and 5000. The practitioner agreed to repay the Commonwealth the sum of $30,000. 

B. No further action decisions

There were no decisions to take no further action in July/August 2024.

C. PSR Committee final determinations

No final determinations came into effect in July/August 2024.

D. Federal Court

Raiz v Director of Professional Services Review [2024] FCAFC 91

Dr Raiz appealed to the Full Federal Court from a judgment of the Federal Court. Two issues emerged in oral argument before the Full Federal Court: 

(1) did the Director consider Dr Raiz’s submissions before deciding to set up the Committee (issue (1)), and

(2) did the absence of the Chairperson on three days of a six-day Committee hearing invalidate its proceeding (issue (2)). 

Dr Raiz was not successful in relation to issue (1) above. 

However, in relation to issue (2), the Full Federal Court found that it was not open to the Committee to conduct part of the hearing in the absence of the Chairperson. 

The Court made the distinction between a Committee hearing and a Committee meeting. Notwithstanding that the Act provides that:

  • a ‘hearing’ is to be conducted at a Committee ‘meeting’, 
  • meetings can proceed with a quorum of members and 
  • a member is to act as Chairperson when the Chairperson is absent at a meeting, 

the Full Court held that those quorum provisions did not apply to hearings, and that all three members must be present for the entire hearing. 

Consequently, the Full Court held that the Draft and Final Reports of the Committee were invalidly made.

The Director has, with the approval of the Commonwealth Solicitor-General, sought special leave to appeal this matter to the High Court.

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

1 matter was referred to the major non-compliance (fraud) division in July/August 2024.

F. Referrals to AHPRA (106XA/B)

2 matters were referred to AHPRA in July/August 2024.

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