Neurologist billed Medicare for phantom consults: PSR

A neurologist will repay $170,000 to Medicare after they admitted to claiming rebates for phantom consultations and unnecessary nerve conduction studies.

The un-named specialist was investigated by the Professional Services Review after falling into the top 1% of doctors billing three MBS items, including item 110 for consultant physician initial attendances.

In its latest outcomes statement, the watchdog said a probe revealed the neurologist billed Medicare for consults that never took place.

“The practitioner did not always perform a separate consultation when billing MBS item 110, nor was a separate consultation always referred or clinically indicated,” the PSR said.

To the extent that a service was provided, the neurologist’s records were inadequate, it added.

They were also in the top 1% for claiming the neuromuscular electrodiagnostic items 11018 and 11021.

Item 11018 covers conduction studies on four or more nerves with or without electromyography or recordings from single fibres of nerves and muscles. Item 11021 covers repetitive stimulation for the study of neuromuscular conduction or electromyography with quantitative computerised analysis.

The doctor’s claiming for nerve conduction studies was criticised, with the PSR finding there was not always a clinical indication for a study involving four separate nerves as required under the item descriptor.

On top of that, there were occasions where “where additional testing appeared to be indicated but did not occur”, it said.

Quantitative electromyography (qEMG) was also performed with insufficient muscle sampling and instead of a standard EMG without clinical indication, according to the statement.

Because they admitted the inappropriate practice, the neurologist was not named in the report, nor were they handed any restrictions on the Medicare claiming in the future.

However they agreed to repay the full $170,000 and accepted an official reprimand, the PSR said.

It came after the watchdog’s outgoing director Professor Julie Quinlivan revealed the agency received 36 cases between April and June 2022, finalising 22.

A total of $5,456,234 in repayment directions were made from the finalised cases, 16 of which involved some form of disqualification from Medicare or the PBS. Some seven practitioners were referred to AHPRA, she said.

Having officially stood down at the end of last month, she will be replaced by Canberra GP and former AMA ACT chair Dr Antonio Di Dio, who was appointed as acting director until September.

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