Doctors and other health practitioners who engaged in questionable prescribing practices have been forced to repay the Commonwealth more than $4.5 million in health benefits in the past year.
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The latest annual report of the national Professional Services Review, which governs the prescribing by health professionals of federally-subsidised Medicare and Pharmaceutical Benefits Scheme services, was released on Tuesday.
It showed 17 general practitioners across four states had to repay $1,630,000 after entering "negotiated agreements" with the PSR in the year to June 30, agreements which include the doctors admitting they engaged in "inappropriate practice".
Inappropriate practice focused on whether a doctor or other health practitioner has inappropriately prescribed PBS or Medicare-subsidised services, and resolutions can range from reprimands to repayment orders and potentially disqualification from claiming subsidies.
Those 17 GPs joined another seven final determinations by the PSR's independent "determining authority" that became "effective", or implemented, which saw the seven other practitioners repay a total of $2,957,291 in Medicare benefits, while some were also subject to reprimands, counselling and partial or full disqualification for three to six months.
One of those seven practitioners was forced to repay Medicare benefits totalling $1,138,463 – a case which is believed to have also led to a full disqualification for three months for the practitioner concerned.
"In most cases reviewed during 2015-16, inappropriate practice involved poor clinical notes, failure to comply with the particular requirements of the MBS items billed to Medicare or unacceptably high numbers of service provision," the report reads.
"Practitioners who were reviewed frequently indicated that they accepted the need to change their practices and were able to demonstrate practical measures undertaken to achieve the required improvements."
The report also showed new referrals of potential inappropriate practice jumped a massive 29 per cent during the 2015-16 year, up from 62 in 2014-15 to 80 last fiscal year – or an 81.8 per cent increase over the two years from 2013-14.
Despite the increase in referrals, the 80 cases referred during 2015-16 represent less than 0.1 per cent of the 85,000 health practitioners whose services attracted Medicare-subsidised payments during the year.
With 88 cases on the PSR's desk at the end of the 2014-15 year, the agency completed 49 cases overall during 2015-16, 24 of which resulted in decisions to take "no further action", 18 of which went to a negotiated agreement that were ratified by the determining authority during the year and a further seven which became "effective" last fiscal year.
The report shows that none of the cases reviewed during 2015-16 resulted in a finding by any of the PSR's committees of "no inappropriate practice" – indicating all the cases dealt with had at least some element of inappropriate action by the doctor concerned.
