Radiologist who altered referrals agrees to repay $3.6 million in Medicare rebates
A radiologist will repay Medicare $3.6 million for inappropriate claims, including some involving rewriting referrals without consulting the referring doctor.
The Professional Services Review (PSR) says the radiologist, who was in the top 1% of providers for 88 Medicare items, was investigated over claims for 10 items, including item 57360 for CT of the coronary arteries, with its $683.10 rebate.
In its latest update, the PSR said it had been concerned that the radiologist was providing different services than those requested, without consulting the referrer or recording clinical justifications.
It also said records of patients who underwent initial and subsequent consultations (MBS items 104 and 105, rebated at $86.15 and $43.35, respectively) suggested some of these consultations may not have occurred or lacked a valid referral.
