A cardiologist was found to have engaged in inappropriate practice in relation to electrocardiogram monitoring, echocardiology studies and initial attendances.
The Professional Services Review has ordered one doctor to repay $1.9 million in Medicare benefits after a committee found that the practitioner’s clinical input during initial consults was inadequate and superficial.
According to the PSR director’s update for June 2025, the practitioner in question – a cardiologist – engaged in inappropriate practice in relation to three MBS items: 110 initial attendance, 11729 multi-channel electrocardiogram monitoring and recording and 55141 exercise stress echocardiography study.
In addition to repaying the full value of the MBS benefits for services related to those three items, the practitioner was reprimanded, fully disqualified from the MBS for 12 months and referred for counselling.
The findings for item 110 were that the recorded assessments were “superficial and did not outline a focused history”, that the patient examination was inadequate, that an adequate history was not taken and that the patient’s medication history and symptoms were not adequately addressed.
The peer committee also said the practitioner did not provide an adequate clinical indication for tests performed or their proposed management plans and that “the medical record was otherwise inadequate”.
For the services in relation to items 11729 and 55141, the committee found that patients were not eligible for those services on the date they happened, that the practitioner’s clinical input was inadequate and the tests were performed sub-optimally and that the practitioner did not provide adequate clinical indication for the tests performed.
The cardiologist was not the only doctor ordered to repay Medicare benefits in June; a GP was also reprimanded, referred for counselling, partially banned from the MBS and ordered to repay $500,000.
These findings were in relation to a number of items.
The GP’s committee of peers found that the practitioner was using generic GP management plan templates that were “not adequately individualised for the patient” and that there was no evidence of two-way communication with other providers involved in the patient’s team care arrangement plans.
Again, the committee cited inadequate patient records.
Of the 10 other cases finalised in June, two were no further action decisions – essentially not-guilty findings.
One of these was a GP who had been referred because it appeared they had rendered 30 or more telehealth phone services on 20 or more days within 12 months.
Upon review though, the PSR director found that the services were claimed appropriately and supported by proper clinical documentation.
“Regarding the prescribed pattern of services, the documentary evidence indicated that the practitioner did not render a prescribed pattern of services, even though they had billed 30 or more relevant phone services on 20 or more days,” the director’s update said.
The other determination of no further action was made because it would be “impossible for a PSR Committee to conduct a proper investigation due to the practitioner’s health”.
In the remaining eight cases, practitioners agreed to repay Medicare benefits or acknowledge inappropriate practice.
