Neurologist banned from claiming MBS electrodiagnosis items, repays $310,000


By Geir O'Rourke

12 May 2022

A neurologist has been handed a 12-month ban on claiming MBS items for neuromuscular electrodiagnosis studies after admitting to inappropriately claiming $310,000 from Medicare.

The specialist came to the attention of the Professional Services Review (PSR) after falling into the top 1% of neurologists billing MBS electrodiagnostic items with an item for complex attendances.

The items included:

  • Item 11018 which covers neuromuscular electrodiagnosis conduction studies on four or more nerves with or without electromyography, or recordings on nerves or muscles.
  • Item 11021 for repetitive stimulation for study of neuromuscular conduction or electromyography with quantitative computerised analysis
  • Item 11024 for an investigation of CNS evoked responses by computerised averaging techniques — not being a service involving quantitative topographic mapping of event-related potentials or multifocal multichannel objective perimetry

The Medicare billing watchdog also investigated the neurologist’s telehealth claims as well as their use of an item for Botox investigations for the treatment of focal spasticity.

This had been billed multiple times for injection into the same muscle with the same motor nerve, which was inconsistent with the MBS item descriptor, said PSR director Professor Julie Quinlivan in an update last week.

An investigation revealed multiple instances where the specialist had claimed the neuromuscular electrodiagnostic items without them being clinically indicated.

And some diagnostic procedures and investigations were “duplicated or performed over multiple days, with each day being billing separately billed to Medicare”.

On top of that, the doctor had billed MBS items for complex physician attendances without spending the minimum required time with each patient per consult, Professor Quinlivan said.

She also criticised the doctor’s note taking, finding consultation records were “not always contemporaneous”.

“The records were generally inadequate,” she said.

Having admitted to inappropriate practice and agreed to repay the full $310,000, the neurologist’s identity was kept confidential as per Section 92 of the Health Insurance Act.

However, they were suspended from claiming the three electrodiagnostic items, plus MBS complex attendance items 132, 133 and their telehealth equivalents.

Separately, the PSR finalised investigations into six GPs and three radiologists, who agreed to repay some $1.4 million in total.

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