Oncologist reprimanded and fined over chemotherapy MBS claims

An oncologist has been reprimanded and forced to repay $135,000 in inappropriate Medicare claims for chemotherapy after being investigated for billing overservicing by the Professional Services Committee (PSR) compliance agency.

In its latest update the PSR said the practitioner – whose name is not revealed – claimed more than 19,000 Medicare Benefit Schedule (MBS) services during the 12 month review period.

The PSR review focused on the oncologist’s claiming of MBS items 112, 116, 13915, 13918, 13921, 13924, 13945 and 14221 for chemotherapy.

It found no inappropriate claiming in relation to MBS items 13915, 13921 and 14221 but concluded there were “persisting concerns” in relation to the remaining items, specifically that the practitioner often billed consultation services in association with chemotherapy and/or line access items.

“In those circumstances, there was often insufficient documentation of a separate consultation that would justify the billing of MBS items 112 or 116,” the PSR Director said.

The review also found that the oncologist’s medical records were inadequate, and at times, there was no record that the service had been provided by the practitioner.

Other problems with the practitioner’s Medicare billing practices included MBS item 112 rendered in circumstances where the patient may not have been eligible for the service; and the MBS requirements were not always met.

“MBS item 13924 appeared to have been billed for subsequent days of treatment where the same infusor was running and MBS item 13945 appeared to have been billed for de-accessing the drug delivery device,” the agency noted.

In its review conclusions, the PSR said the oncologist had acknowledged that they had engaged in inappropriate practice and agreed to repay $135,000.

The oncologist was disqualified from providing MBS item 13924 (‘Cytotoxic chemotherapy, administration of, by intravenous infusion of more than 6 hours duration – on each day subsequent to the first in the same continuous treatment episode’) for 12 months, and reprimanded by the Director.

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