A neurologist has been reprimanded and will repay almost a quarter of a million dollars for inappropriate Medicare claims relating to EEG monitoring and other MBS items.

In its latest update of investigations into overservicing, Medicare’s compliance watchdog the Professional Services Review said an un-named neurologist had been audited after they were found to be rendering MBS services in excess of 99% per cent of their peers.

The PSR investigation focused on the neurologist’s rendering of several MBS items including item 11005, which covers prolonged ambulatory or video EEG, recording of at least 3 hours duration for  diagnosing the basis of episodic neurological dysfunction; characterising the nature of a patient’s epileptic seizures; localising seizures in patients with uncontrolled epilepsy, with a view to surgery; or assessing treatment response where subclinical seizures are suspected.

After reviewing the claims, the PSR said it had “persisting concerns that there was no process to determine which diagnostic tests were clinically indicated”

The investigation also found that technicians were inadequately supervised when reviewing EEG data and developing reports, and there was no report completed in respect of every investigation billed to Medicare.

The audit suggested that not all services rendered by the neurologist were clinically indicated and some services were billed prior to each service being completed.

“The practitioner acknowledged having engaged in inappropriate practice in connection with providing these items of concern. The practitioner agreed to repay $246,081 and will be reprimanded by the Director.