A rheumatologist has been ordered to repay $275,000 to Medicare after admitting to inappropriately claiming items for management plans and telehealth.
The specialist was investigated by the Professional Services Review (PSR) over their claims for items 132 and 133, which cover assessments to prepare and (or in the case of item 133) review a treatment and management plan.
This followed data analysis showing they had claimed the two items in excess of 99% of other rheumatologists over a 12 month period, with the PSR also examining their rendering of MBS item 92431, the then phone equivalent of 132.
In addition, the doctor’s prescribing of duloxetine 60mg capsules under the PBS was scrutinised, although PSR acting director Dr Antonio Di Dio said there were no ‘persisting concerns’ identified in relation to that issue.
On the other hand, there was not always evidence of adherence to some basic elements of the descriptors for the relevant MBS items, particularly the 20- and 45-minute minimum time requirements, he said in the agency’s February update (link here).
“It was also unclear whether the practitioner always provided MBS item 132 and 133 services to patients with multiple morbidities as required,” he wrote.
Additionally, requirements were not always met for MBS items 132 and 92431 where services did not involve initial assessments of the patient and for MBS item 133 where the patient had not been billed under MBS item 132 in the preceding 12 months.
Because the rheumatologist admitted to the inappropriate claiming, they were not identified in the update, but they did agree to repay the full $275,000 and to undergo counselling from the PSR director.
General physician in hot water over record keeping
Meanwhile, a general physician agreed to repay $342,000 after admitting to inappropriate practice in connection with rendering MBS attendance items 110, 116, 132 and 133.
Also in the top percentile of claimers for items 132 and 133, they were found to have inadequate records, which “did not always reflect that they had provided sufficient clinical input to meet the respective minimum time requirements” for the two items, Dr Di Dio said.
“Their clinical notes were brief, and often omitted relevant clinical information,” he wrote.
Beyond that, he said the investigation had raised concerns that the physician did not appropriately manage patients with delirium and cognitive impairment.
“For example, it was not always clear from the record whether they used objective measurement tools, obtained psychologist or psychiatrist input or took appropriate steps to ensure such patients had adequate support in their decision making.”
In addition to the repayment order, the unnamed doctor will be disqualified from claiming MBS items 110 and 91824 for six months and will be counselled by the acting director.