A sleep medicine specialist has been reprimanded by the Professional Services Review (PSR) and ordered to repay $1.2 million he received from Medicare for sleep studies under MBS item 12250.
The doctor, whose name has been withheld in the report by the Medicare claims watchdog, was also disqualified for six months from item 12250 (‘overnight investigation of sleep for a period of at least 8 hours of a patient aged 18 years or more to confirm diagnosis of obstructive sleep apnoea’).
According to the latest case outcomes released by the PSR director, the doctor failed to keep adequate records, failed to supervise the technician and scorer adequately and did not provide adequate clinical input into MBS item 12250 services.
In the July update, the PSR director gives examples of poor record keeping, such as the doctor using the date when the sleep investigation commenced for billing purposes rather than the date that he completed the service.
Examples of poor supervision include allowing sleep technicians to make cursory records of patient history and omitting significant conditions such as COPD, and failing to give more details than ‘blood pressure’ as a comorbidity.
Technicians also failed to record patients’ medication history, smoking and alcohol history, or make a record of the patient’s sleep position.
The PSR determination concluded that the doctor failed to meet the requirements of the 12250 item descriptor in not personally confirming the necessity of the investigation before it took place.