Haematologist forced to repay $510,000 for ‘inappropriate’ Medicare claims

An unnamed haematologist has been reprimanded and forced to repay $510,000 by Medicare auditors as a result of “inappropriate practice” in relation to five MBS items.

The latest report from Medicare’s Professional Services Review (PSR) watchdog, the repayment was agreed following a review of the practitioner’s rendering of MBS items 112, 116, 132, 133 and 14221.

The item numbers broadly cover;

  • 112 – attendance by video conferencing
  • 116 – attendance after the first in a single course of treatment
  • 132 – minimum 45 minute initial assessment of a patient with at least two morbidities
  • 133 – minimum 20 minute review of a patient with at least two morbidities
  • 14221 – accessing of long-term implanted device for delivery of therapeutic agents

“The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items,” the PRS report said.

There were no concerns from the PRS about the practitioner’s rendering of MBS items 13706 – relating to the blood or bone transfusions – and 13750, in relation to therapeutic haemapheresis.

In addition to the repayment of the $510,000 the haematologist would be “reprimanded by the director”, the agency said.

The case comes of the wake of the last PSR annual report in which it said it would be widening its scope of audits to take a closer look at Medicare claiming by specialities such as haematology and rheumatology.

In the last financial year it had clawed back $20 million from practitioners. More than half of the actions involved amounts of more than $200,000.

PSR agreements with practitioners are confidential.

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