A respiratory and sleep medicine specialist has been reprimanded by the Medicare claims watchdog and ordered to repay almost half a million dollars for inappropriate claiming of sleep studies MBS items.
The un-named practitioner was reviewed by Medicare’s Professional Services Review (PSR) in relation to MBS items 11503 for complex lung function tests and item 12250 for unattended home-based sleep studies.
According to the latest PSR bulletin, the PSR Director “had persisting concerns that: for MBS item 11503, the test had not been ordered by the referring GP, the practitioner did not supervise the test or provide quality assurance, and there was no independent report of the test.”
For MBS item 12250, the PSR Director was concerned that there was inadequate consideration of clinical indication for the study, the practitioner’s supervision was inadequate, and the reports were inadequate.
“The practitioner acknowledged they engaged in inappropriate practice in connection with providing these items of concern. The practitioner agreed to repay $470,000, to be disqualified from providing MBS items 11503 for 12 months, and will be reprimanded by the Director,” the PSR statement said.
The reprimand follows major revisions to respiratory function test and sleep study items implemented in November 2018 by Medicare in response to major growth in billing for sleep item numbers.
In its most recent newsletter the Australian Sleep Association said many sleep physicians had asked for clarification about the administration of the questionnaires for items 12203 and 12250.