PSR Director's update for September 2025

Published date

A. Section 92 agreements effective in September 2025

Nine 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 September 2025:

Cardiologist

During the review period, the practitioner rendered the highest volume of MBS item 110 (initial attendance by physician) services compared to all providers who billed this item under Medicare. They also provided the following MBS item services in excess of 99% of their peers:

  • 11714 (twelve-lead electrocardiography)
  • 11729 (multi-channel electrocardiogram)
  • 55127 (repeat serial transthoracic echocardiographic examination)
  • 61345 (myocardial perfusion study)

The Director reviewed this practitioner’s provision of MBS item 110, 11729, 55126 (initial transthoracic echocardiographic examination), 55127 and 61345 services, and had no concerns in relation to MBS item 55126 services. The Director had persisting concerns that:

  • for MBS item 110 services, the MBS requirements were not always met, including failing to provide adequate clinical input for a consultation that required a cardiac assessment and treatment plan
  • when providing MBS item 11729, 55127 and 61345 services, the clinical indication was not always clear, including when there were alternative investigations available
  • the practitioner’s record keeping was inadequate and often made it difficult to discern what condition the patient had presented with and the practitioner’s clinical input during the consultation.

The practitioner acknowledged having engaged in inappropriate practice in connection with providing MBS Item 110, 11729, 55127 and 61345 services. The practitioner agreed to:

  • repay $500,000
  • be reprimanded by the Director
  • be counselled by the Director.

Obstetrician and gynaecologist

During the review period, the practitioner rendered the second highest volume of MBS item 55278 (duplex scanning) services compared to all providers who billed this item. The practitioner also rendered MBS item 55700 (pregnancy related or pregnancy complication ultrasound scan) services in excess of 99% of their peers. 

The Director reviewed this practitioner’s rendering of MBS item 104 (initial specialist attendance), 55278 and 55700 services, and had no concerns in relation to MBS item 55700 services. The Director had persisting concerns that:

  • the practitioner billed MBS items 104 and 55700 services when there was no personal attendance by the practitioner on the patient, and it appeared that genetic counsellors or sonographers had attended the patient
  • the practitioner rendered MBS item 55278 services when they were not requested, and in circumstances that were unrelated to its intended purpose 

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 104 and 55278. The practitioner agreed to repay $310,000 and to be counselled by the Director.

Medical practitioner

During the review period, the practitioner rendered the highest volume of MBS item 279 (attendance for mental disorder lasting at least 20 minutes) and 282 (mental health plan) services compared to all providers who billed these items. The practitioner also relevantly rendered the following MBS item services and prescribed the following PBS items in excess of 99% of their peers:

MBS item:

  • 57 (attendance between 45 and 60 minutes) services

PBS items:

  • 13321D (buprenorphine + naloxone)
  • 3133X (oxazepam 30 mg)
  • 3162K (diazepam 5 mg)
  • 5338Y (clonazepam 2 mg)
  • 8370M (naltrexone 50 mg)
  • 8457D (quetiapine 100 mg)

An Associate Director reviewed this practitioner’s rendering of MBS item 57, 279 and 282 services, and prescribing of PBS items 13321D, 1849H (sumatriptan 50 mg), 3133X, 3162K, 5338Y, 8370M and 8457D. 

The Associate Director had persisting concerns that:

  • the MBS item requirements were not always met, including failing to meet minimum time requirements and not undertaking clinically relevant actions
  • MBS item 279 services were not always rendered in relation to a mental disorder
  • PBS medications were sometimes prescribed when it was not clinically indicated
  • the practitioner’s record keeping was not always adequate, including failing to include sufficient clinical information to enable another practitioner to effectively undertake the patient’s ongoing care in reliance on the record.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 57, 279 and 282 services and prescribing of PBS items 13321D, 1849H, 3133X, 3162K, 5338Y, 8370M and 8457D. The practitioner agreed to:

  • repay $165,000
  • be disqualified from providing MBS item 57, 279, 91805 (video attendance more than 45 minutes and not more than 60 minutes), 91913 (phone attendance more than 45 minutes and not more than 60 minutes), 92121 (video attendance at least 20 minutes) and 92133 (phone attendance at least 20 minutes) services for 6 months
  • be reprimanded by the Associate Director
  • be counselled by the Associate Director.

General practitioner

During the review period, the practitioner was ranked tenth nationally among all providers for MBS item 91801 (telehealth attendance at least 20 minutes) services. They also relevantly rendered or initiated the following MBS item services in excess of 99% of their peers:

  • 44 (attendance at least 40 minutes)
  • 63551 (MRI scan of head)
  • 63554 (MRI scan of spine)
  • 92024 (telehealth attendance for preparation of GP mental health plan)
  • 92025 (telehealth attendance to coordinate team care arrangements)
  • 92028 (telehealth attendance to review GP management plan or team care arrangements)
  • 92127 (phone attendance relating to mental disorder at least 20 minutes)

An Associate Director reviewed this practitioner’s provision of MBS item 36 (attendance at least 20 minutes), 44, 2713 (attendance for GP mental health plan), 63551, 63554, 66839 (quantification of methylmalonic acid or homocysteine), 91801 (phone attendance at least 20 minutes), 91891 (phone attendance at least 6 minutes), 92024, 92025, 92028 and 92127 services.

The Associate Director had persisting concerns that:

  • the MBS requirements were not always met, including minimum time requirements and where consultations were to be conducted by video rather than phone
  • the practitioner’s clinical input was not adequate for chronic disease management services, and associated documents were of poor quality
  • the practitioner’s initiation of MRI scans and pathology services were not always clinically indicated
  • the practitioner’s record keeping was inadequate, with many records being largely templated without sufficient individualisation.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 36, 44, 2713, 63551, 63554, 66839, 91801, 91891, 92024, 92025, 92028 and 92127 services. The practitioner agreed to:

  • repay $210,000
  • be disqualified from providing MBS item 965 (prepare GP chronic condition management plan), 967 (review of a GP chronic condition management plan), 92029 (video attendance to prepare GP chronic condition management plan and 92030 (video attendance to review a GP chronic condition management plan) services for 12 months
  • be reprimanded by the Associate Director
  • be counselled by the Associate Director.

General practitioner

During the review period, the practitioner ranked third nationally for MBS item 23 (level B consultation) services. The Director reviewed this practitioner’s rendering of MBS items 23 and 5020 (level B consultation after hours), and provision of a prescribed pattern of services (rendering 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 80 or more relevant services on each of 22 days during the review period and exceptional circumstances did not exist that affected the rendering of services on those days
  • the practitioner billed level B consultations for services such as vaccinations which peers would not consider required a level B consultation
  • the practitioner’s record keeping was inadequate because of their heavy reliance on templates that lacked sufficient personalisation, and which did not always specify what occurred during the consultation.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Item 23 and 5020 services and the services they provided on days on which they provided 80 or more professional attendance services. The practitioner agreed to repay $290,000 and to be counselled by the Director.

General practitioner

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

  • 723 (coordination of team care arrangements)
  • 92024
  • 92025
  • 92028

An Associate Director reviewed this practitioner’s rendering of MBS item 721, 723, 732, 91801, 92024, 92025 and 92028 services. The Associate Director had persisting concerns that:

  • there were often no documented GP management plans or team care arrangements, and if there were, they were often not sufficiently comprehensive or personalised, nor was there two‑way collaboration with other health care providers
  • for MBS item 91801 services, the practitioner often did not attend the patient by video or did not provide sufficient clinical input to meet the minimum time requirement
  • across all reviewed services the practitioner’s record keeping was inadequate.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Item 721, 723, 732, 91801, 92024, 92025 and 92028 services. The practitioner agreed to: 

  • repay $125,000
  • be disqualified from providing MBS item 965, 967, 92029 and 92030 services for 12 months
  • be reprimanded by the Associate Director
  • be counselled by the Associate Director.

General practitioner

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

  • 91801
  • 91891
  • 92210 (telehealth attendance after hours)

An Associate Director reviewed this practitioner’s rendering of MBS item 36, 91801, 91891 and 92210 services, and their provision of a prescribed pattern of services (rendering of 30 or more relevant phone services on 20 or more days in a 12‑month period). The Associate Director had no persisting concerns relating to MBS items 36, 91801, 91891 and 92210 services.

The Associate Director had persisting concerns that the practitioner rendered 30 or more relevant phone services on each of 45 days during the review period and exceptional circumstances did not exist that affected the rendering of services on those days.

The practitioner agreed to repay $45,000, and to be reprimanded by the Associate Director.

General practitioner

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

  • 44
  • 91890

An Associate Director reviewed this practitioner’s rendering of MBS item 36, 44, 91890 and 91891 services and provision of a prescribed pattern of services (rendering of 30 or more relevant phone services on 20 or more days in a 12‑month period). The Associate Director had no concerns in relation to MBS item 91890 services, but had persisting concerns that:

  • the practitioner rendered 30 or more relevant phone services on each of 51 days during the review period and exceptional circumstances did not exist that affected the rendering of services on those days
  • the MBS requirements were not always met, including instances where the minimum time requirements were not met
  • the practitioner’s record keeping was inadequate as their notes did not always reflect sufficient clinical input.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS Item 36, 44 and 91891 services and the services they provided on days on which they provided 30 or more phone attendance services. The practitioner agreed to:

  • repay $65,000
  • be reprimanded by the Associate Director
  • be counselled by the Associate Director.

General practitioner

During the review period, the practitioner rendered the second highest volume of MBS item 91891 services compared to all providers who billed this item under Medicare. The practitioner also prescribed the following PBS items in excess of 99% of their peers: 

  • 1215Y (paracetamol + codeine)
  • 2089Y (temazepam 10 mg)
  • 2622B (oxycodone 5 mg)
  • 3162K (diazepam 5 mg)

An Associate Director reviewed this practitioner’s provision of a prescribed pattern of services (rendering of 30 or more relevant phone services on 20 or more days in a 12‑month period), their rendering of MBS item 91891 services, and prescribing of PBS items 1215Y, 2089Y, 2622B and 3162K. The Associate Director had persisting concerns that:

  • the practitioner rendered 30 or more relevant phone services on each of 29 days during the review period and exceptional circumstances did not exist that affected the rendering of services on those days
  • the MBS requirements for MBS item 91891 services were not always met and clinical input was not always documented
  • the PBS requirements were not always met and the records lacked sufficient clinical detail to justify the prescribing of PBS items, and lacked other details such as reviews of the medication, tapering plans, pain assessments or functional goals
  • the practitioner’s record keeping was inadequate, often with records lacking sufficient detail to allow another practitioner to take over care in reliance on the records.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 91891 services, prescribing of PBS items 1215Y, 2089Y, 2622B and 3162K, and the services they provided on days on which they provided 30 or more phone attendance services. The practitioner agreed to:

  • repay $110,000
  • be reprimanded by the Associate Director
  • be counselled by the Associate Director.

B. No further action decisions

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

C. PSR Committee final determinations

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

A final determination regarding PSR Committee 1614 came into effect in July 2025.

PSR Committee 1614

On 31 July 2025, a final determination came into effect regarding a general practitioner. In the final report of the PSR Committee, the practitioner was found to have engaged in inappropriate practice in connection with MBS item 36, 44, 5040, 5060 (afterhours attendance lasting at least 40 minutes), 91809 (phone attendance lasting less than 20 minutes) and 30064 (removal of subcutaneous foreign body) services, and PBS item 8319W (amoxicillin and clavulanic acid) services provided during the review period.

The practitioner was directed to:

  • be reprimanded
  • be counselled
  • repay the amount of $145,000
    • This reflects approximately 100% of the Medicare benefits that were paid for the MBS item 36, 44, 5040, 5060, 91809, and 30064 services in connection with which the practitioner was found to have engaged in inappropriate practice.
  • be disqualified from rendering MBS item 36, 44, 5040 and 5060 services for a period of 12 months, and MBS item 91891 services for a period of 6 months.

In relation to MBS item 36, 44, 5040 and 5060 services, the Committee made findings based on one or more of the following:

  • The practitioner’s records were inadequate, often being very brief and not including a sufficiently detailed or extensive patient history, the examinations performed, or a management plan for the patient.
  • The practitioner’s clinical input was not adequate, including instances where they failed to explore relevant histories, perform relevant examinations and investigations and/or failed to appropriately address the presenting complaint.
  • The MBS requirements were not always met, including meeting minimum time requirements and the practitioner did not take a detailed history of the patient.

In relation to MBS item 91809 services, the Committee made findings based on one or more of the following:

  • The MBS requirements were not always met, including the record not indicating whether the consultation was conducted via phone or face to face and no history or management plan was recorded.
  • The service rendered was not always one where it was appropriate to render an MBS item 91809 service, including where the consultation was simply to provide results of a test, or where the patient was an inpatient at a public hospital.
  • The medical record was otherwise inadequate.

In relation to MBS item 30064 services, the Committee made findings based on one or more of the following:

  • The MBS requirements were not always met, including where the procedure did not relate to removal of a subcutaneous foreign body, or the procedure did not require exploration and wound closure.
  • In all instances the practitioner co-billed a longer attendance item but there was insufficient clinical input documented to support this.
  • The medical record was otherwise inadequate.

In relation to PBS item 8319W, the Committee made findings based on one or more of the following:

  • The practitioner’s clinical input was not adequate as the recorded symptoms did not indicate that the patient’s condition was bacterial, rather than viral, and required antibiotic treatment
  • The PBS requirements were not met and there was no indication that the infection was suspected or proven to be resistant to amoxicillin.
  • The medical record was otherwise inadequate. 

D. Federal Court

There were no federal court decisions handed down in September 2025.

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

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

F. Referrals to AHPRA (106XA/B)

There were no matters referred to AHPRA in September 2025.

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