A rheumatologist has been reprimanded by the Medicare watchdog after admitting to inappropriate practice related to prescribing of biologics and ordering of bone densitometry services.
The Professional Services Review (PSR) investigated the un-named specialist physician after data analysis revealed they held multiple national top rankings for PBS prescribing of biologics and MBS claims for BMD testing.
The practitioner was the nation’s top PBS prescriber of the anti-TNF golimumab and methotrexate, and ranked first nationally for initiating bone densitometry diagnostic item 12315, the PSR Director’s update for October 2024 revealed (link here).
The practitioner was also ranked third nationally for PBS prescriptions for tofacitinib and upadacitinib.
The investigation focused on initial and subsequent specialist attendances (MBS items 110 and 116), multiple bone densitometry items, and prescribing of several biologics and DMARDs including methotrexate, secukinumab, golimumab, baricitinib, tofacitinib and upadacitinib.
PSR Director Professor Antonio Di Dio reported “persisting concerns” about the practitioner’s record keeping, which was described as “vague” with “incorrect details about patient presentation and management.”
MBS requirements were not always met, including eligibility requirements for bone densitometry services, while the rheumatologist “did not personally determine whether each bone densitometry procedure was clinically indicated,” according to the report.
PBS requirements were also not consistently met, with Professor Di Dio citing inadequate clinical input in prescribing decisions.
The rheumatologist acknowledged inappropriate practice related to initiating bone densitometry items 12306, 12315 and 12322, as well as prescribing of secukinumab, golimumab, upadacitinib and methotrexate.
It comes amid a growing focus from the PSR on claims by specialists, with another rheumatologist ordered to repay $275,000 in rebates earlier this year after admitted to inappropriate prescribing and claims of MBS items 132, 133 and 92431 .
All told, three cardiologists, three neurologists and two endocrinologists have come before the watchdog since the start of this year, alongside more than three dozen GPs and handful of non-medical practitioners and doctors from other specialties.
In the current case, the rheumatologist was not ordered to repay any money but was reprimanded by the PSR director. They cannot be named under Section 92 of the Health Insurance Act.