A dermatologist has been ordered to repay nearly $2 million to the federal government after being found guilty of inappropriate billing of Medicare by the Professional Services Review.
The money, $1,946,352.15 in all, represents 12 months of the un-named specialist’s claims for just three MBS items, including one attendance item (105) and two covering PUVA and/or UVB therapy (14050 and 14053).
A PSR committee investigation found issues with respect to the former, mostly related to record keeping, which were so deficient as to warrant a finding of inappropriate practice, the watchdog said.
In one case, there was “no record of an MBS item 105 service being provided on the date of the service,” it added in its update for March 2024 (link here).
Beyond that, there were serious concerns raised about the dermatologist’s provision of the latter two items.
Issues related in the update included that the treatment was administered by another party, but not under supervision by the dermatologist, whose clinical input into the service was either inadequate or undocumented.
In relation to one MBS 14050 service, there was no contemporaneous record of a service meeting the MBS requirements being provided on the date of service, the update said.
In addition, MBS requirements were not met for some MBS 14053 services as the treatment involved using an Excimer lamp held by hand by the operator who directed the radiation to a very limited portion of skin instead of administration of radiation in a ‘hand and foot cabinet’ as required by the MBS descriptor.
The repayment is the largest ever required of a dermatologist by the Medicare compliance watchdog, exceeding a previous 2022 agreement with a dermatologist to repay $237,450 for inappropriate MBS item claims.
In recent years the PSR has given notice that it is expanding its remit to investigate Medicare compliance activity in a wider range of specialties, including dermatology.
This month the PSR announced its newest acting director, Dr Sarah Mohoney, after Dr Antonio Di Dio stepped down after two years in the role.
Dr Mahoney, currently a medical adviser at the Department of Health and Aged Care, officially took on the role on 10 April.
“Her career includes over 30 years’ clinical experience as a general practitioner in a variety of settings including rural and urban general practice, emergency medicine and early detection of breast cancer,” the agency said in an announcement.
“She also has extensive experience in clinical education, with previous roles including coordinating clinical practice training at the University of Melbourne and Associate Professor and Academic Coordinator of the Onkaparinga Clinical Education Program in the Flinders University MD program.”
It added: “PSR has been fortunate to have had Associate Professor Antonio Di Dio act in the position of Director for some time, however he has reached the legislated limit of time a person can be appointed to act in a vacant statutory role.”
“Associate Professor Di Dio will continue to work with PSR as Medical Officer.”