The Medicare compliance watchdog is targeting specialists’ use of MBS items and has already clawed back millions for inappropriate claims.
In its latest annual report the Professional Services Review (PSR) says it has widened its enforcement actions beyond the traditional focus on GPs, to encompass specialists such as rheumatologists and haematologists.
In 2017/18 it recovered $20 million from specialists, GPs and other practitioners, with the amounts repaid ranging from $15,000 to $2 million and more than half involving amounts more than $200,000.
The PSR says its investigations into specialist billing focused on MBS consultation items 104 ($87) and 105 ($44).
“Findings of inappropriate practice have been made when consultation items have been billed in association with procedural items when there is no evidence of a separate consultation, there is a lack of a valid referral, and there is a concern about poor documentation of the patient history, examination, diagnosis and management plan by the specialist,” its report says.
“In some cases, consultations have been performed by assistants, with little evidence of clinical input from the specialist practitioner in the core elements of the medical consultation.
As a result, PSR Director Professor Julie Quinlivan has issued a warning to specialists in the PSR’s latest monthly update.