Two cardiologists have fallen foul of the Medicare claims compliance watchdog, with each being made to repay hundreds of thousands of dollars for inappropriate billings.
In its latest outcomes report the Professional Services Review Scheme (PSR) includes details of a cardiologist whose rendering of MBS items 132, 133 and 11610 were found to have exceeded 99% of their peers.
After auditing the practitioner’s Medicare claims the PSR had concerns that MBS requirements for item 132 and 133 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 cardiologist also made claims for services were not clinically indicated, such as ankle brachial indices tests (MBS item 11610) for screening purposes rather than based on a patient history or examination
The PSR reprimanded the practitioner and came to an agreement to repay $190,000.
A second cardiologist was made to repay $130,000 after they were found to be overservicing compared to their peers for MBS items 132, 133, 11712 (ECG Stress Testing) and 55113 (plain echo).
In its review the PSR noted that the cardiologist did not prepare treatment and management plans and the claims for ECG Stress Tests did not always identify the attending practitioner or contain a formal report of the results of the procedure.
In addition to repaying the claims, the cardiologist was reprimanded and disqualified from providing MBS items 132 and 133 for 12 months.
However some doctors are pushing back against PSR audits, saying the process is unfair and penalises practitioners who made claims in good faith.
According to a report on the ABC, Brisbane GP Dr Anchita Karmakar is launching a legal challenge against the PSR after being forced to repay $500,000 in claims.
She said the claiming guidelines were vague, leading to clinicians being retrospectively penalised despite believing they were following the rules.