Context
Monthly round up Here’s a summary of PSR cases and other FWA activity PSR Case Reports March 2025 In the month of March 6 section 92 agreements and 3 final determinations came into effect. One of the agreements was made with an Obstetrician and Gynaecologist, one with a Radiation Oncologist, and four with GPs. Half of these practitioners were disqualified from billing certain items for a period. The three final determinations related to a GP, a dentist and an ophthalmologist respectively. These practitioners were all disqualified from billing certain items for a period. The maximum repayment across all practitioners for March was $700,000, which was enforced against a dentist. The findings included: The consent obtained from the patients’ parents did not correctly describe the services to be performed The medical record was inadequate The practitioner was sometimes not present Removal of calculus did not take place on the date of service Fissure seals were not performed on the date of service The service was not clinically indicated These very troubling findings – billing for services not provided and billing for services when the practitioner was not even present – amount to fraud in our view, not inappropriate practice. The GP cases involved the usual litany of common findings – MBS requirements not met, services not clinically necessary, inadequate record keeping, and inadequate particularisation of templates. The agreement with the obstetrician/gynaecologist was interesting given it involved billing of the standard pregnancy planning and management item – 16590. The findings were: services billed under the practitioner’s provider number were not always personally...
