Endocrinologist forced to repay $800,000 to Medicare

Thursday, 20 Feb 2020

An endocrinologist has been forced to repay $790,000 to Medicare after being found to have over-serviced MBS consultant physician attendance items by the claims compliance watchdog.

In its report for January 2020, Medicare’s Professional Services Review (PSR) Agency says the un-named practitioner is also being banned from providing MBS items 132 and 133 for 12 months.

Its audit of the physician’s claims found that they had billed more than 15,000 services during the six month review period.

MBS items 132 and 133 are consultant physician items providing higher Medicare benefits for long and comprehensive consultations.Item 132 is for initial attendance of at least 45 minutes duration to undertake a comprehensive assessment of the patient and develop a treatment and management plan. (schedule fee for this item is $272.15). Item 133 is for a subsequent attendance of at least 20 minutes duration to review the initial diagnoses, problems and responses to treatment and to revise the treatment and management (schedule fee $136.25)

The PSR agency said it found that the MBS requirements for these items were not always met by the endocrinologist, including the minimum time requirements.

“In services where MBS items 132 and 133 were billed, there was often no evidence that a comprehensive management plan was created addressing physical psychological and social factors; the records did not always reflect that the practitioner personally attended the patient when billing attendance items [and] the practitioner did not always keep adequate records of the services they provided,” it said.

“In particular, the practitioner’s letters back to the referring GP did not contain sufficient clinical detail; not all services were clinically indicated; and the practitioner did not always provide adequate clinical input into each service.”

The PSR said the endocrinologist had acknowledged they engaged in inappropriate practice in connection with providing these items and would receive a reprimand as well as repaying the cost of the items of concern.

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