High claiming haematologist repays $330,000 for MBS transfusion items

A haematologist has agreed to repay $330,000 to Medicare for inappropriate MBS item claims after being targeted for investigation by the Professional Services Review (PSR) compliance body.

The un-named haematologist came to the attention of the PSR as the highest ranked renderer of MBS items 132 and 133 (initial and review of a patient with at least two co-morbidities) among haematologists nationally.

Auditors found there were concerns about the haematologists practice, such as there not always being a clinical indication when rendering MBS item 132 and 133 services.

“For example, not all of these services were provided to patients who had at least two morbidities that warranted a treatment and management plan of significant complexity,” they noted.

The reviewed records did not always reflect that the MBS requirements were met, including minimum time requirements where relevant, they added.

Investigations also highlighted concerns about the doctor’s claims for blood transfusion MBS items 13703 and 13706.

“The reviewed records indicate that MBS items 13703 and 13706 were billed when the practitioner provided iron infusions, rather than transfusions of blood or blood products

They also concluded that the haematologist’s records did not always reflect that the practitioner provided sufficient clinical input, and the records were inadequate.

“The practitioner agreed to repay $330,000, to be disqualified from providing MBS items 132, 133, 13703 and 13706 for 12 months, and will be reprimanded by the Director,” the PSR notification concluded.

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