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...

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