GP repays $455,000 in rebates and cops six-month ban on claiming MBS item 23

The GP was in the top 1% of claimants for various skin excision and consultation items.

A GP has agreed to repay almost half a million dollars to Medicare after admitting inappropriate claims for various skin procedures and consultation items, the Professional Services Review (PSR) says.

The watchdog handed the GP a six-month ban on claiming MBS items 23, 36 and 91801 (telehealth consultations lasting at least 20 minutes) and a 12-month ban on MBS claims for removing subcutaneous foreign bodies. 

The PSR also investigated the GP over claims for five skin excision items for which they were in the top 1% of claimants, such as item 31363 for removal of a malignant skin lesion with a necessary excision diameter of 14mm or greater.

And it investigated the GP’s claims for items 30061 and 30064 — removal of a superficial and subcutaneous foreign body, respectively — plus item 31364 for the removal of cysts, ulcers, scars and other non-malignant lesions (schedule fee $184.05) and item 30029 for wound repairs of no more than 7cm long (schedule fee $98.60). 

The PSR said the GP’s records often lacked sufficient clinical information to justify the procedures. 

“When patients had multiple lesions requiring excision, the practitioner appeared to excise these at separate attendances without a clear clinical reason for doing so,” the PSR added. 

It said MBS requirements around lesion size were not always met and that “when providing level B and C attendance items, the practitioner did not always perform specified tasks in the MBS item descriptors when these would have been clinically relevant”.

The GP admitted to inappropriate practice over his claims for these items, as well as claims for level B and C consultations and their telehealth equivalents, after-hours attendance items and 12-lead ECGs.

They agreed to repay $455,000 in rebates.

In its update for September 2023, the PSR also revealed that a dentist was investigated and ordered to repay $133,399 to the Child Dental Benefits Scheme for claims for plaque removal and remineralisation that had inadequate clinical justification.  

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