The Director of the Professional Services Review (PSR) estimates that in 2018-19 over $29 million will be repaid by medical practitioners as a result of inappropriate practice in connection with Medicare billing. This is part of the government’s focus on enhancing the Medicare compliance process, including an increased review of specialties other than general practice.
This article was originally published on the MDA National website.
The PSR Director’s Update for June 2019 noted that ten agreements had been entered into between the Director of the PSR and medical practitioners (persons under review):
- A general surgeon who billed more than 17,000 services in the year agreed to repay $500,000 and was disqualified from providing some MBS items for 12 months
- A GP who billed more than 15,000 services in the year agreed to repay $428,000 and was disqualified from providing some MBS items for 24 months and other items for 12 months
- A rehabilitation medicine specialist who agreed to repay $170,000 and was disqualified from providing an MBS item for 12 months
- A respiratory and sleep medicine specialist who billed MBS item 12250 on more than 5,000 occasions in the year and agreed to repay $900,000
- A GP who billed in excess of 84% of their peers despite having a patient load that was on the 38thcentile and billed chronic disease management services in excess of 99% of their peers. The GP agreed to repay $350,000 and was disqualified from providing some MBS items for 12 months
- A GP who billed more than 16,000 services in the year agreed to repay $160,000 and was disqualified from providing some MBS items for 12 months
- A medical practitioner who billed long consultation items in excess of 99% of their peers agreed to repay $400,000 and was disqualified from providing some MBS items for 12 months
- A medical practitioner who agreed to repay $200,000 and was disqualified from providing one MBS item for 12 months
- A GP who agreed to repay $460,000 and was disqualified from providing some MBS items for six months and other items for 12 months
- A GP who agreed to repay $130,000 and was disqualified from providing some MBS items for 12 months.
Common themes in these cases include:
- medical records were either inadequate or non-existent
- inadequate, or inadequately recorded clinical input
- services were not clinically indicated
- specific MBS requirements, including minimum time requirements, were not met.
All MDA National members are encouraged to contact the Medico-legal Advisory team should the Department of Health contact you about your Medicare billing.
More information about the PSR process can be found here.