Blood cancers

Haematologist repays $1.4 million to Medicare for inappropriate claims

An un-named haematologist has been forced to repay $1.4 million to Medicare for inappropriate claiming of 40,000 items relating to blood transfusion and chemotherapy services.

In its update for August 2019 the Medicare claims compliance watchdog, the Professional Services Review says the haematologist was reprimanded and banned from claiming certain items for a year.

The 40,000 MBS services investigated were claimed over a one year period and included professional attendance items 110 (Fee $155.60), 116 ($77.90), 132 ($272.15) and 133 ($136.25).

The other specific MBS items reviewed were:

  • Item 13706 (Transfusion of blood, or platelets or white blood cells or bone marrow or gamma globulins, Fee $84.70)
  • Item 13757 (Therapeutic venesection for the management of haemochromatosis, polycythemia vera or porphyria cutanea tarda, Fee $74.10)
  • Item 13915 (Cytotoxic chemotherapy administration, Fee $66.10)
  • Item 13942 (Cancer chemotherapy delivery via an ambulatory device, Fee $66.30)

The PSR said its Director Professor Julie Quinliven had persisting concerns that MBS requirements were not met in regard to services were not clinically indicated and the medical records were inadequate.

“The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items of concern. The practitioner agreed to repay $1,400,000, to be disqualified from providing MBS items 132, 133, 13942 for 12 months, and will be reprimanded by the Director,” the statement said.

In 2018 the PSR announced it would be extending its traditional scope from primary care to look more closely at Medicare claims by specialist physicians. This included the appointment of haematologists Professor John Gibson and Dr Emma Palfreyman to the PSR panel.

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