A sleep and respiratory physician has agreed to repay $2 million after the Professional Services Review found persisting billing problems with sleep studies and respiratory function tests.
The case was the largest of 11 section 92 agreements to take effect in April 2026, detailed in the PSR director’s update published earlier this month.
During the review period, the physician rendered more total services than 99% of their peers, and recorded the highest national volume of four MBS items: 11503 (complex measurement of properties of the respiratory system, including the lungs and respiratory muscles), 12203 (overnight laboratory sleep study), 12204 (overnight assessment of positive airway pressure) and 12250 (overnight home sleep study).
PSR director Associate Professor Antonio Di Dio examined the physician’s billing of those four items alongside item 110, the initial consultant physician attendance, and found persisting concerns across the board.
For item 110 services, the requirements “were not always met, including where the service was not for an initial attendance in a single course of treatment,” and the physician’s “clinical input was sometimes inadequate,” the report found.
Item 11503 services were “not always clinically indicated,” with some performed “in association with other items prohibited by the MBS item descriptor,” or where results of the procedure were never formally reported.
The sleep study billing drew similar scrutiny. Patients were “not always seen by a qualified sleep medicine practitioner” before items 12203 and 12204 were billed, and “there was not always an assessment of clinical necessity,” the report found.
Of particular concern to Associate Professor Di Dio was the prospect that gaps in recording pressure determination studies meant patients may have been prescribed the wrong CPAP pressure altogether, with the report citing “the possibility patients were prescribed an inadequate CPAP level due to the deficiency in recording pressure determination studies.”
Eligibility checks for a related item also fell short, with the report finding the physician did not appropriately assess “whether a patient was eligible for this study.”
The physician acknowledged engaging in inappropriate practice across all five items and agreed to be counselled by the PSR director, alongside the $2 million repayment, the largest financial penalty disclosed in the update.
The physician was not named, consistent with PSR’s standard approach to section 92 agreements, which are negotiated outcomes rather than findings from a full committee hearing.
The update also recorded a final determination against an endocrinologist, ordered to repay $400,000 after a PSR committee found attendance items were billed for telehealth consultations conducted by text message, and in-person reviews that did not meet minimum time requirements.
In total, the April and May period produced 11 section 92 agreements, two no further action decisions, five Committee final determinations, one Federal Court judgment, and one referral each to the fraud and AHPRA divisions.