Context
Monthly round up Here’s a summary of PSR cases and other FWA activity PSR Case Reports April 2025 In the month of April 3 section 92 agreements and 6 final determinations came into effect. Two of the agreements were made with General Practitioners and one with a Plastic Surgeon. All of these practitioners were disqualified from billing certain items for a period. The six final determinations related to two chiropractors and four GPs, all of whom were also disqualified from billing certain items for a period. It is quite unusual to see full disqualification from all MBS billing, but this month one GP was fully disqualified from rendering MBS item services for 24 months and another was fully disqualified for 3 months. The maximum repayment across all practitioners for March was $537,000, which was enforced against a GP. This month the troubling findings against the various practitioners were extensive including: MBS requirements were not met. Medical records were inadequate. Clinical input was insufficient or inadequate. Services were not clinically relevant. For services provided by or in part by another practitioner, a Medicare benefit was not payable, and it was inappropriate for the practitioner to bill MBS items such as 23, 721, 723, 732 and 2713. Templates were not sufficiently particularised. The MBS time requirements were not met. CT scans and pathology studies were not clinically relevant. Upcoding – billing for a longer or more complex service than was provided. Some of the procedures billed by the plastic surgeon were not clinically justified. It was a litany of poor behaviour that...
