PSR Director's update for October 2026

Published date

11 November 2026

A. Director’s Section 92 agreements effective in October 2026

The Chief Executive Medicare referred the following practitioners to PSR for review.

The Director or an Associate Director entered into 5 agreements with persons under review under s 92 of the Act that came into effect in October 2026:

Optometrist

The Director reviewed this practitioner’s rendering of the following Medicare Benefits Schedule (MBS) item services:

10912 (first attendance in a course of attention, lasting at least 15 minutes, if the patient has suffered significant change of visual function requiring comprehensive reassessment)
10913 (first attendance in a course of attention, lasting at least 15 minutes, if the patient has new signs or symptoms requiring comprehensive reassessment)
10914 (first attendance in a course of attention, lasting at least 15 minutes, if the patient has a progressive disorder (excluding presbyopia) requiring comprehensive reassessment)
10940 (full quantitative computerised perimetry).

The Director had persisting concerns that:

the MBS requirements were not always met, including where:
- patients did not have a significant change of visual function, new signs or symptoms, or a progressive disorder that would require comprehensive reassessment
- there was insufficient clinical indication for some full computerised perimetry services performed
- some MBS item 10912, 10913 and 10914 services billed were not the first in a course of attention
the practitioner failed to perform gonioscopy to check angles for pigment clogging for a patient with possible pigment dispersion syndrome or did not refer patients with possible glaucoma for Optical Coherence Tomography scans
the practitioner inappropriately co-billed MBS items 10912 and 10914 when patients attended for a single contact lens consultation or fitting service
the practitioner’s records were not always adequate, including when they did not include sufficient clinical information to explain the service.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS items 10912, 10913, 10914 and 10940. The practitioner agreed to:

be reprimanded by the Director
be counselled by the Director
repay $100,000 to the Commonwealth.

General practitioner

An Associate Director reviewed this practitioner’s rendering of the following MBS item services:

23 (professional attendance lasting at least 6 minutes and less than 20 minutes)
36 (professional attendance lasting at least 20 minutes)
715 (health assessment for a patient of Aboriginal or Torres Strait Islander descent)
721 (preparation of a general practitioner management plan (GPMP))
723 (coordination of team care arrangements (TCAs))
732 (review or coordinate a review of a GPMP or TCA)

The Associate Director had no persisting concerns in relation to the practitioner’s rendering of MBS item 715 services. In relation to the remaining items, the Associate Director had persisting concerns that:

the MBS requirements were not always met, including where the respective minimum time requirements were not met for MBS item 23 and 36 services and the practitioner did not always consult with collaborating health providers when providing MBS item 723 or 732 services
the reviews for MBS item 723 services were generic and unlikely to be of benefit to the patient
the practitioner’s clinical records were inadequate. Some records were largely based on templates or included pre-written paragraphs that were inaccurate or not adequately personalised to the patient’s presentation. The documentation for MBS item 721 and 723 services was not sufficiently comprehensive or personalised to the patient
the practitioner’s clinical management was not always appropriate, including when they provided services that were not clinically indicated.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS items 23, 36, 721, 723 and 732. The practitioner agreed to:

be reprimanded by the Associate Director
be counselled by the Associate Director
repay $120,000 to the Commonwealth
be disqualified from providing MBS item 967 (attendance for review of a GP chronic condition management plan) and 92030 (video attendance for review of a GP chronic condition management plan) services for 6 months.

Medical practitioner

The Director reviewed this practitioner’s rendering of the following MBS item services:

30216 (aspiration of a haematoma)
32500 (varicose veins, multiple injections of sclerosant)
32520 (varicose veins, abolition of venous reflux by occlusion of a primary or recurrent great or small saphenous vein)
55246 (unilateral duplex scanning of veins in the lower limb, for chronic venous disease).

The Director had no persisting concerns in relation to the practitioner’s rendering of MBS item 32500, 32520 and 55246 services.

In relation to MBS item 30216 the Director had persisting concerns that the MBS requirements were not always met, as the practitioner billed this item for the removal of trapped blood rather than the aspiration of a haematoma.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS item 30216. The practitioner agreed to be counselled by the Director and to repay $7,700 to the Commonwealth.

Nurse practitioner

An Associate Director reviewed this practitioner’s rendering of the following MBS item services:

91179 (video attendance by a nurse practitioner lasting at least 20 minutes)
91189 (phone attendance by a nurse practitioner lasting between 6 and 20 minutes)
91190 (phone attendance by a nurse practitioner lasting at least 20 minutes).

The Associate Director also reviewed this the practitioner’s prescribing of the following Pharmaceutical Benefits Scheme (PBS) items:

2237R (sertraline 100 mg tablet, 30)
8701Y (escitalopram 20 mg tablet, 28)

The Associate Director had no persisting concerns in relation to MBS item 91189 services. In relation to the remaining items, the Associate Director had persisting concerns that:

the MBS requirements, including the minimum time requirements, were not always met
the practitioner’s clinical management of patients was not always adequate, including failing to follow up with drug dependant patients where expected
the practitioner’s clinical records were not always adequate, with no notes being kept for some services, and a substantial lack of clinical detail and inaccuracies in relation to others
the practitioner’s prescribing was inappropriate, including in circumstances where:
- the medication was not clinically indicated
- the respective PBS restrictions were not met
- the practitioner’s clinical input when prescribing was not always adequate.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS items 91179 and 91190 and prescribing PBS items 2237R and 8701Y. The practitioner agreed to:

be reprimanded by the Associate Director
be counselled by the Associate Director
repay $185,000 to the Commonwealth
be disqualified from providing MBS item 91179 and 91190 services for 12 months.

General Practitioner

An Associate Director reviewed this practitioner’s rendering of the following MBS item services:

23
36
705 (attendance to perform a long health assessment lasting between 45 and 60 minutes)
715
721
723
732
5020 (professional attendance in the after-hours period, lasting at least 6 minutes and less than 20 minutes)
5040 (professional attendance in the after-hours period, lasting at least 20 minutes)
91891 (phone attendance lasting at least 6 minutes).

The Associate Director had persisting concerns that:

the MBS requirements were not always met, including where:
- the minimum time requirements where relevant were not met, and clinically relevant actions required by the relevant item descriptor were not undertaken
- health assessment or chronic disease management services were provided to patients who were not eligible for these services
- GPMP and TCA documents were not sufficiently comprehensive and the practitioner did not consult with at least two other healthcare providers when coordinating or reviewing TCAs
the practitioner’s clinical care was sometimes inadequate, including in circumstances where they:
- did not provide any clinical input when creating GPMPs and did not review all components of GPMPs and TCAs during services billed as MBS item 732
- prescribed medications without proper clinical indication or discussing the potential for adverse reactions
- failed to diagnose, treat or investigate a patient’s presenting condition
the practitioner’s clinical records were inadequate, including where they were largely based on impersonalised templates and did not include clinically relevant information.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS items 23, 36, 705, 715, 721, 723, 732, 5020, 5040 and 91891. The practitioner agreed to:

be reprimanded by the Director
be counselled by the Director
repay $620,000 to the Commonwealth
be disqualified for 12 months from providing MBS item 36, 705, 715, 967, 5040, 91800 (video attendance lasting between 6 and 20 minutes), 91891, 91900 (phone attendance lasting at least 20 minutes, for a patient registered under MyMedicare with the billing practice), 92004 (video attendance for health assessment), and 92030 services
be disqualified for 6 months from providing MBS item 965 (attendance to prepare a GP chronic condition management plan) and 92029 (video attendance to prepare a GP chronic condition management plan) services.

B. No further action decisions

General practitioner

The Director reviewed this practitioner’s rendering of MBS item 23, 36, 91891 and 92210 (video attendance in unsociable hours for a patient whose condition requires urgent assessment) services.

After reviewing the practitioner’s records, the Director formed the view that no further action was required as there were insufficient grounds on which a Committee could reasonably find that the practitioner engaged in inappropriate practice during the review period.

Cardiologist

The Director reviewed this practitioner’s rendering of the following MBS item services:

11716 (continuous ambulatory electrocardiogram recording for 12 or more hours)
38212 (cardiac electrophysiological study)
38287 (ablation of arrhythmia circuit or focus or isolation procedure involving one atrial chamber)
38290 (ablation of arrhythmia circuits or foci, or isolation procedure involving both atrial chambers and including curative procedures for atrial fibrillation)
55054 (ultrasonic cross-sectional echography, in conjunction with a surgical procedure using interventional techniques)
61109 (fluoroscopy in an angiography suite with image intensification, in conjunction with a surgical procedure using interventional techniques).

C. PSR Committee final determinations

PSR Committee regarding a nurse practitioner

On 30 October 2026, a final determination came into effect regarding a nurse practitioner. In the final report of the PSR Committee, the practitioner was found to have engaged in inappropriate practice in connection with rendering MBS item 91179, 91180 (video attendance by a nurse practitioner, lasting at least 40 minutes), 91190 and 91191 (phone attendance by a nurse practitioner, lasting at least 40 minutes) services during the review period.

The Determining Authority directed that the practitioner:

be reprimanded by the Director, or the Director’s nominee
repay $200,000 to the Commonwealth, which reflects approximately 80% of the Medicare benefits paid for the services in connection with which the practitioner was found to have engaged in inappropriate practice during the review period
be disqualified from rendering any MBS item services for 24 months
be suspended from prescribing under the PBS for 24 months.

The Committee found that:

the practitioner participated in a system of work and permitted their provider number to be used by third parties without taking sufficient steps to ensure that their provider number was being used to bill appropriately, including understanding which item numbers would be billed, which resulted in the third parties billing for services that were longer than the consultations that occurred to attract higher Medicare rebates.
the practitioner’s understanding of their clinical role as a nurse practitioner and accountability for clinical decisions was limited, with the practitioner exhibiting a pattern of willingness to defer to patients on clinical decision making
the practitioner’s clinical management was not always adequate, including in circumstances where:
- they did not perform an adequate clinical assessment prior to prescribing potentially harmful medications to patients, including nicotine vaping products and medicinal cannabis, including failing to consider contraindications, perform risk screening, or discuss risks with patients
- their prescribing of PBS medications was not clinically appropriate, including where the record did not reflect a prescription of molnupiravir was clinically indicated or that patients met the PBS criteria for this medication
- the clinical record did not include adequate information to support diagnoses made by the practitioner, including when this diagnosis was the basis for prescribing medication under the PBS or initiating pathology services

In relation to each of the MBS item 91179, 91180, 91190 and 91191 services reviewed, the Committee made findings based on one or more of the following:

the practitioner did not meet relevant minimum time requirements for billed services, and did not always undertake all clinically relevant actions required by the relevant MBS item descriptors
services rendered as video consultations were billed as phone consultations, and vice versa
in relation to some MBS item 91190 services, the reviewed records did not reflect an attendance took place on the date the service was purportedly provided.
the practitioner’s medical records were inadequate. Their clinical records were universally brief, often replicating previous entries, and lacking information and diagnoses beyond what the patient had reported in their intake forms, and there was a general lack of management planning and preventative healthcare advice recorded

D. Federal Court

There were no Federal Court decisions relating to PSR matters in October 2026.

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

No matters were referred to the major non-compliance (fraud) division in October 2026.

F. Referrals to AHPRA (106XA/B)

2 matters were referred to AHPRA in October 2026.