Rheumatologist ordered to repay almost $1m for incorrect MBS billings

A Perth rheumatologist has been reprimanded and ordered to repay Medicare nearly $950,000 after a Professional Services Review Committee found he made inappropriate billings and kept inadequate records.

Dr Robert Will of Victoria Park, WA, was investigated by the Medicare compliance agency for his work as both a consultant rheumatologist and as the owner of a company (Osteoporosis Solutions) performing bone densitometry scans.

He was directed to pay the Commonwealth $947,529.82 for a “large number” of incorrect billings in both areas of his practice.

In relation to his billings as a consultant rheumatologist, the PSR committee found the physician’s records were “generally brief and similar across services” rather than reflecting what occurred at particular consultations.

“While patients were always seen, the reviewed services did not always meet the requirements of the relevant MBS item descriptor,” the PSR Director said in her April 2021 update.

The services at issue were for MBS Item 110 (initial attendance); Item 132 (initial attendance of more than 45 minutes with a referred patient with at least two co-morbidities); and Item 133 (subsequent attendance of at least 20 minutes).

In addition, the committee had “serious concern” that information on PBS Authority forms did not reflect the patient record for some services, but contained inaccurate information intended to enable patient access to Commonwealth-subsidised medicines.

In relation to the bone densitometry services,  the PSR found that Dr Will did not provide the requisite level of clinical input from a consultant rheumatologist as he did not write, or have adequate involvement in the preparation of, the report for the relevant services.

“There was also a persisting lack of documented referrals for these services in circumstances where a referral was required,” Director Professor Julie Quinliven said.

“The committee had concerns that repeated bone densitometry scans were recommended by Dr Will in circumstances where they were not clinically indicated.”

The densitometry billing investigation related to MBS items 12306 (minimal trauma fractures or monitoring of low BMD), 12312 (long term steroid therapy, male or female hypogonadism), 12315 (Primary hyperparathyroidism, chronic liver or renal disease, malabsorptive disorders, RA or any condition associated with thyroxine excess), 12321 (establish or confirm low BMDafter a change in therapy) and 12323 (patients over 70).

Dr Will was reprimanded and ordered to undertake counselling.

Already a member?

Login to keep reading.

Email me a login link

© 2022 the limbic