PSR Director's update for July 2026

A. Section 92 agreements effective in July 2026

One agreement entered into by an Associate Director and the person under review (under section 92 of the Act) came into effect in July 2026:

General practitioner

During the review period, the practitioner rendered a prescribed pattern of services (rendering 30 or more relevant phone services on 20 or more days in a 12-month period), and the following MBS item services in excess of 99% of their peers:

• 721(preparation of a general practitioner management plan (GPMP))
• 723 (coordination of team care arrangements (TCAs))
• 91891 (phone attendance lasting at least 6 minutes)

The Associate Director reviewed this practitioner’s rendering of MBS item 721, 723, 5020 (after-hours attendance lasting at least 6 minutes and less than 20 minutes) and 91891 services.

Following review of the practitioner’s rendering of relevant phone services, including considering additional information provided by the practitioner, the Associate Director no longer had concerns that the practitioner had rendered a prescribed pattern of services. The Associate Director had persisting concerns that:

• the practitioner’s record keeping did not meet the standard of adequate and contemporaneous records as they were often brief and lacked sufficient detail to explain the service, and sometimes included discrepancies regarding the dates of service and how the service was provided
• the practitioner did not always meet MBS or record keeping requirements when rendering chronic disease management services, including that: 
  • many of the plans were not sufficiently comprehensive and did not demonstrate collaboration with other health care providers, or it was unclear what the other provider’s role was or the treatment/services they would provide
  • some patients did not appear to have a chronic condition and would not have been eligible for a GPMP or TCA
• for MBS item 91891 services, the MBS requirements, particularly the minimum time requirements, were not always met.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS item 721, 723, 5020 and 91891 services. The practitioner agreed to:

• repay $130,000 to the Commonwealth
• be disqualified from providing MBS item 965 and 92029 services for 3 months
• be reprimanded by the Associate Director.

B. No further action decisions

General practitioner

During the review period, the practitioner rendered MBS item 721, 723, 732, 2717, 2712 and 2725 services in excess of 99% of their peers.

Due to various factors relating to the practitioner’s personal circumstances, the Acting Director was satisfied that circumstances existed that would make it impossible for a PSR Committee to conduct a proper investigation. 

C. PSR Committee final determinations

PSR Committee regarding a general practitioner 

On 24 July 2026, 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 the rendering of the following MBS item services during the review period: 

• 23 (attendance lasting at least 6 minutes and less than 20 minutes)
• 36 (attendance lasting at least 20 minutes)
• 44 (attendance lasting at least 40 minutes)
• 707 (attendance for health assessment lasting at least 60 minutes)
• 721
• 723
• 5040 (afterhours attendance lasting at least 20 minutes)
• 5060 (afterhours attendance lasting at least 40 minutes)
• 90051 (attendance at a RACF lasting at least 40 minutes)
• 91891

The practitioner was directed to:

• be reprimanded 
• be counselled
• repay $260,000 to the Commonwealth 
  • This reflects approximately 100% of the Medicare benefits paid for the individual services rendered in relation to MBS item 23, 36, 44, 707, 721, 723, 5040, 5060, 90051 and 91891 services in connection with which the practitioner was found to have engaged in inappropriate practice during the review period.
• be disqualified from rendering MBS items 707, 965, 967, 92029 and 92030 for 18 months
• be disqualified from rendering MBS items 44, 5060 and 90051 for 6 months.

In relation to MBS item 23, 36 and 44 services, the Committee made findings of inappropriate practice based on one or more of the following:

• For many of the services, the practitioner did not provide sufficient clinical input to justify billing the item or meet the minimum time requirement.
• The practitioner did not always perform clinically relevant actions, such as not taking an adequate history or not performing an adequate examination. 
• Across the services, the practitioner’s record keeping was inadequate. 

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

• For many of the services, the practitioner did not provide sufficient clinical input to justify billing the item or meet the minimum time requirement. 
• Several services did not occur or did not substantially occur in the after-hours period.
• The practitioner did not always perform clinically relevant actions such as not taking a detailed history or not performing an adequate examination.

In relation to MBS item 90051 services, the Committee made findings based on one or more of the following:

• For all services, the practitioner did not provide sufficient clinical input to meet the minimum time requirement. 
• Across the services, the practitioner’s record keeping was inadequate. 

In relation to MBS item 91891 services, the Committee made findings based on one or more of the following: 

• For some services, the practitioner’s record keeping was inadequate. 
• For some services, the practitioner did not provide sufficient clinical input to meet the minimum time requirement. 

In relation to MBS item 707, the Committee made findings based on one or more of the following: 

• The health assessment conducted by the practitioner did not meet the MBS requirements, including that:
  • in a small number of services, the practitioner did not attend on the patient on the date of service to conduct a health assessment
  • the practitioner did not provide sufficient clinical input on the date of service to meet the minimum time requirement
  • the health assessments mostly consisted of prepopulated information and lacked any comprehensive information collection
  • there was not an extensive examination of the patient’s medical condition
  • there was not an extensive physical examination of the patient 
  • there were either no recommendations at all, or no recommendations that would assist the patient with management of their condition
  • there was no preventative healthcare management plan included for the patient
  • the practitioner co-billed MBS item 10997 (service provided by a nurse to a patient with a chronic condition consistent with a GPMP or TCA) when the nurse did not attend the patient or provided a service that was not consistent with an existing GPMP or TCA.

In relation to MBS item 721 and 723, the Committee made findings based on one or more of the following: 

• The MBS requirements were not met for MBS item 721 services, including that:
  • none of the GPMPs were comprehensive written plans and they lacked management goals to which the patient had agreed
  • the GPMPs did not always identify the chronic diseases to which the plan was intended to relate or adequately describe the patient’s healthcare needs 
  • basic metrics such as blood pressure, height, weight, pulse and past blood sugar were usually auto populated but were not used in the planning of the patient’s health needs, such as developing management goals. 
• There was not always a separate TCA document in the record, however, the practitioner appeared to use the GPMP as the relevant document for TCA services.
• For MBS item 723 services, the MBS requirements were not met, including that:
  • for some services there was no document in the patient record to reflect the content of a TCA
  • the document did not describe the treatment and service goals of the patient
  • any treatment services to be provided by the collaborating providers were not adequately described
  • the actions to be taken by the patient were not adequately described.
• For both MBS item 721 and 723 services, the MBS requirements for the co‑billed MBS item 10997 service were not met. There was either no separate service provided by a nurse, or when there was a service provided by a nurse, it was not consistent with an existing GPMP or TCA.

In relation to services reviewed by the Committee where the practitioner billed MBS items 44, 721 5040, 5060 and 91891, the practitioner had produced some non‑contemporaneous records to the Committee. These records had either been created or altered at a time after the PSR review process had commenced.

D. Federal Court

There were no Federal Court judgments handed down in relation to PSR matters in July 2026.

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

There were no matters referred to the major non-compliance (fraud) division in July 2026.

F. Referrals to Ahpra (106XA/B)

Three matters were referred to Ahpra in July 2026.