Context
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...
