medicare

Dealing with the Professional Services Review Agency

There have also been record increases in the number of referrals made and in the number of services falling under scrutiny in each review. Whereas, traditionally, general practitioners have been the PSR’s primary focus, greater diversity of speciality is a continuing trend with more dentists, chiropractors, nurse practitioners, independent midwives and optometrists finding themselves subject to the PSR’s processes in the last year....

PSR continues to recover significant payments in 2019

The first two months of 2019 has seen the Director of the Professional Services Review (PSR) enter into 9 agreements with practitioners which will result in repayments totalling $2,840,000. 5 of the 9 practitioners were general practitioners. The maximum single repayment was $550,000.00. The agreements were made pursuant to section 92 of the Health Insurance Act 1973 (Cth) with practitioners who ...

GP ordered to repay $450,000 for inappropriate billing

Dr Nicholas Sevdalis maintained that he made handwritten records which he subsequently transferred to an electronic record. However, the Committee held that the handwritten documents which were tendered in evidence were not contemporaneous and were “recent fabrications”. Dr Sevdalis unsuccessfully appealed the Committee’s decision to the Federal Court, and ultimately appealed to the Full Bench of the Federal Court....

Professional Services Review Annual Report 2015-16

In 2015/16 there was an increase in the number of investigations of Chronic Disease Management and MBS Health Assessment items. Many practitioners providing high numbers of these services were found to use computer-generated templates leading to plans with minimal content specific to the patient for whom it had been prepared. Further, some team care arrangement plans were made without ...

Abuse of MBS privileges improper and unethical

A nurse practitioner was found to have engaged in professional misconduct after billing Medicare inappropriately and engaging in multiple boundary violations. The nurse practitioner provided therapy at centres providing crisis and homeless accommodation to adults and worked in collaboration with 3 psychiatrists. He also provided psychotherapy at his own Clinic where the majority of patients were referred from the crisis centres....

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