Here’s a summary of PSR cases and other FWA activity PSR Case Reports November 2024 In the month of November 6 section 92 agreements and 2 final determinations came into effect. 5 of the agreements were made with GPs and 1 with an Oral and Maxillofacial Surgeon. 3 GPs were disqualified from billing certain items and/or prescribing certain medications for a period. The maximum repayment across all practitioners for November was $495,000, which was enforced against a GP who billed MBS items 23, 36 and 44 (level D consultation) and 66596 (iron studies) in excess of 99% of their peers. The findings against this GP included that the practitioner’s record keeping was inadequate, MBS requirements were not always met including minimum time requirements and there was no clinical indication for some of the iron studies. The Oral and Maxillofacial Surgeon was found to have inappropriately billed various procedures including local skin flaps, operations on the mandible or maxilla, reduction of maxillary tuberosities, wound debridement and trigeminal nerve blocks. The surgeon was required to repay $150,000, and was disqualified from claiming items 18234, 30023, 45815, 45829 for 3 months. The two final determinations were both against GPs. The first GP was found to have incorrectly billed services for patients at Residential Aged Care Facilities. This included inadequate history taking, inadequate records, missing entries for the dates of service billed, patients not needing urgent assessment when urgent items were billed and inadequate clinical input. The second GP was found to have incorrectly billed various skin lesion services including laser photocoagulation, skin flaps and...

Here’s a summary of PSR cases and other FWA activity PSR Case Reports October 2024 In the month of October 19 section 92 agreements and 1 final determination came into effect. 17 of the agreements were made with GPs, 2 with specialists (a radiologist and a rheumatologist) and the final determination was against an ophthalmologist. 9 GPs were disqualified from billing certain items and/or prescribing certain medications for a period. The maximum repayment across all practitioners this month was $625,000, which was enforced against a GP who was ranked 1st nationally for rendering item 732, 2nd for item 723 and 3rd for item 721. The findings against this GP included that the practitioner did not always attend the patient when required, did not provide adequate clinical input, and did not meet minimum time requirements for the items billed. The radiologist was found to have inappropriately billed bone densitometry services, as well as mouth x-rays and orthopantamography, and was required to repay $200,000, though was not disqualified. The rheumatologist inappropriately claimed high volumes of bone densitometry services and the aggravating factors associated with this case were egregious in our view. They included the records having incorrect details about the patient’s presentation and management, and Dexa scans being performed on patients who were ineligible for them. Inexplicably, this practitioner was neither disqualified nor required to make any repayment. The ophthalmologist was found to have inappropriately billed items 104, 42702 (lens extraction and insertion) and 42788 (laser capsulotomy). This case is a salient reminder that you cannot automatically bill a separate attendance item...