Cardiologist repays $330k for overclaiming MBS angiography items

A cardiologist who had the highest rate of MBS billings for peripheral artery disease imaging has agreed to repay $330,000 in excess claims to  Medicare.

The unnamed practitioner came to the attention of Medicare’s Professional Services Review after being noted as the top ranked provider of MBS item 60048 (‘Digital subtraction angiography, examination of lower limb or limbs’) out of all active cardiologists nationally.

The PSR Director investigated the practitioner’s rendering of various other MBS item services and noted various concerns, including inadequate records kept for long consultations for review and care planning (MBS items 132 and 133)  and MBS requirements were not met.

“For example, for MBS items 132 and 133, the services were provided to patients who did not have at least two morbidities that warranted the preparation or review of a treatment and management plan of significant complexity, the PSR Director noted.

The investigation also found that with MBS items 59925 (Selective Coronary arteriography and angiocardiography) and 60048 the practitioner co-billed with MBS item 38218 (Selective coronary angiography – native coronary arteries with right or left heart catheterisation or both or aortography) when services which these two items cover are components of the overall comprehensive MBS item 38218 service.

Other concerns identified included not all services being clinically indicated and patient consent not always appropriately obtained and documented for procedures.

The practitioner acknowledged having engaged in inappropriate practice in connection with rendering MBS items 132, 133, 55113, 55116 and 60048, the PSR Director noted in their August 2021 outcomes statement.

“The practitioner agreed to repay $330,000, to be disqualified from providing MBS items 132, 133 and 60048 services for 12 months and will be reprimanded by the Director.

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