An optometrist whose name will not been revealed in accordance with section 92 of the Health Insurance Act , has been directed to repay $57,059.01 to the Commonwealth.
The optometrist was also disqualified from rendering MBS items 10913 and 10914 for six months.
Professional Services Review committee decision
The directions were made by the Professional Services Review committee on 27 October, after it concluded that the optometrist engaged inappropriate practice in connection with rendering MBS items10913 and 10914.
The committee found that the practitioner’s record-keeping in connection with the MBS items 10913 and 10914 services that it reviewed was, on occasion, inadequate. That occurred when, for example, history, diagnoses, follow-up arrangements or examination findings were either not recorded or not recorded in sufficient detail.
Patient must be seen by optometrist at same practice
MBS item 10913 requires, amongst other things, that a patient with new signs or symptoms previously been seen at the same practice as the providing optometrist. In the committee’s view, that meant the patient must be seen by an optometrist at the same physical practice, not at another practice within a corporate group.
The committee’s view was that failure to meet that regulatory requirement on its own and in the absence of any other conduct of concern would be considered unacceptable to the general body of optometrists.
There were numerous services in the random sample of services where the patient had not been seen previously at the practitioner’s practice location.
Access to previous ocular information required
Ascertaining whether a patient has presented with a new sign or symptom requiring a comprehensive reassessment requires access to previous ocular information. The purpose of the item is a reassessment, implying that there is some baseline from which to reassess.
In a number of cases, the committee made adverse findings cases that patients who attended the practitioner either did not have new signs or symptoms or did not have new signs or symptoms that would have warranted a comprehensive reassessment. On several occasions, the committee also found that the practitioner did not perform a comprehensive assessment.
Must be comprehensive reassessment of disorder
In relation to MBS item 10914, this item is only to be billed for the comprehensive reassessment of progressive disorder. The Committee found on a number of occasions that the patient did not have a progressive disorder or, if they did, a comprehensive reassessment was not clinically indicated.
In a number of cases, the committee found that the practitioner had recorded a diagnosis of posterior subscapular cataract without a clinical basis for such a diagnosis. In some cases, a comprehensive examination was also not performed or the practitioner’s clinical input into service was inadequate.