An endocrinologist has been handed a 12 month ban on using MBS specialist consultation and telehealth items after they admitted inappropriately claiming $340,000 from Medicare.
The Professional Services Review (PSR) said it launched an investigation after the doctor was identified in the top 1% of claimants for three MBS items over a 12-month period.
It found repeated examples where the MBS requirements were not met for items 132 and 133, covering consults of at least 45 minutes and 20 minutes respectively.
These included consults which went under the required time as well as occasions when items were claimed for patients who were ineligible under the item’s descriptors – which specified referrals had to be provided by another practitioner.
And in some instances, plans and management were “not of sufficient complexity”, PSR director Professor Julie Quinlivan said in an agency update last week.
She added not all services were clinically indicated.
For example, there was not always adequate clinical indication for consultation attendances or for thyroid ultrasounds initiated, she said.
The endocrinologist was not named because they admitted to inappropriate practice and agreed to repay the $340,000 in full.
They were also disqualified from billing the two MBS consultation items, along with their telehealth equivalents, for 12 months.
It came as Professor Quinlivan warned specialists to expect greater scrutiny from the Medicare watchdog, which had moved away from its traditional focus on GPs in recent years.
“If I look at my current committee list, I have chiropractors, nurse practitioners, midwives, optometrists, dentists, a whole range of specialists and only a few GPs,” she told the limbic.
“It really wasn’t fair in the past that compliance was just for GPs, it really should be on everybody.
“Besides that, we are now looking at corporates as well as individual doctors. That’s really important, because it brings accountability to corporate practice.”
Separately, a cardiologist agreed to repay $10,000 after admitting to inappropriately claiming the same two MBS consultation items.
Another four doctors, all GPs, admitted inappropriate practice to the watchdog, agreeing to repay $1.4 million to Medicare in total.