A cardiologist has agreed to repay $500,000 and receive a reprimand from the director of the Professional Services Review after their use of MBS items for attendances and cardiac tests came under scrutiny.
The clinician billed the highest volume of MBS item 110, for initial attendance by a physician, of any Medicare biller in the country over the 12-month review period.
PSR director Associate Professor Antonio Di Dio said he had concerns the requirements of this billing item were not always met by the practitioner, while there were cases of “failing to provide adequate clinical input for a consultation that required a cardiac assessment and treatment plan”.
The use of items 11729 (multi-channel electrocardiogram), 55127 (repeat serial transthoracic echocardiographic examination) and 61345 (for myocardial perfusion study) were also reviewed, with the director concerned the clinical indication for these items was not always clear.
“The practitioner’s record keeping was inadequate and often made it difficult to discern what condition the patient had presented with and the practitioner’s clinical input during the consultation,” Associate Professor Di Dio noted in his director’s update for September 2025 noted [link here].
He said the specialist agreed to a reprimand and to be counselled by the director, as well as the repayment of $500,000.
The cardiologist’s case was one of nine agreements between the PSR director and clinicians in September.
Other cases included a obstetrician and gynaecologist who repaid $310,000 and was counselled by the director after a review of their billing for pregnancy-related ultrasounds.
Associate Professor Antonio Di Dio said he held concerns the specialist had billed MBS item 104 for initial specialist attendance and 55700 for pregnancy related or pregnancy complication ultrasound despite only a sonographer or genetic counsellor being in attendance.
The clinician had also billed the second-highest volume of item 55278, a duplex scan for analysis of renal or visceral vessels, though the director questioned if there were cases where this scan was not requested or fit for purpose.
GP attendance in the spotlight
Six GPs also agreed to repay a cumulative total of $845,000 after the PSR ran the ruler over services including telehealth billing, chronic disease management plans and attendance items.
One of those general practitioners will repay $210,000 and was disqualified from providing a range of MBS items, including 965 for the preparation of a chronic disease management plan, for 12 months.
The associate director of the PSR had concerns “clinical input was not adequate for chronic disease management services, and associated documents were of poor quality”.
Another GP agreed to repay $290,000 and be counselled by the director after their use of level B consultation items came under review.
The clinician was the third highest biller in the nation for item 23 during the review period, and the director had concerns this item was being used for services like vaccinations, which their peers would not consider require a ‘level B’ consult.
Other cases agreed to in September included:
• A medical practitioner received a reprimand and was disqualified from providing a range of attendance items, including MBS item 57 (attendance between 45 and 60 minutes), for six months. Concerns were raised about a failure to meet minimum time requirements. The clinician agreed to repay $165,000.
• A GP agreed to repay $125,000 after acknowledging inappropriate practice in connection with GP management plans and chronic disease management plan items.
• A separate GP who had billed phone and video attendance items in excess of 90% of their peers also agreed to repay $45,000 after the associate director reviewed their billing patterns. The associate director had concerns the GP “rendered 30 or more relevant phone services on each of 45 days during the review period and exceptional circumstances did not exist that affected the rendering of services on those days”.
The PSR committee delivered no new final determinations in September.
However, a previous final determination came into effect in July 2025, in a case which found a GP had engaged in inappropriate practices around a range of items including attendance, removal of a foreign body from skin and the provision of PBS item 8319W (amoxicillin and clavulanic acid).
The GP was directed to repay $145,000, and be counselled and reprimanded by the director.