MBS item scrutiny profile
MBS Item 23 — PSR scrutiny profile
Appears in 17 published determinations since 2022, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Inadequate documentation9
- Chronic disease management6
- Clinical appropriateness5
- Mental health treatment plan5
- After-hours billing4
- MBS requirement breach3
- PBS prescribing3
- Time based billing3
Specialties involved
- General Practice11
- Unknown6
Repayment range
Calculated only across the 16 published cases where a repayment amount is recorded.
Published cases mentioning item 23
Section 92 Agreement with General Practitioner for Excessive and Inappropriate Billing and Prescribing
Practitioner acknowledged inappropriate practice; agreed to repay $600,000; reprimanded and counselled by Associate Director; disqualified from providing certain MBS items for 12 to 24 months
$600,000
Section 92 Agreement with General Practitioner for Inappropriate MBS Item Rendering
Practitioner acknowledged inappropriate practice; agreed to repay $212,000; reprimanded by Associate Director; disqualified from providing certain MBS items for 12 months
$212,000
Section 92 agreement with General Practitioner for inappropriate MBS item claims
Practitioner agreed to repay $340,000 to the Commonwealth, be counselled by the Associate Director, and be disqualified from providing MBS items 967, 965, 92029 and 92030 for 3 months.
$340,000
Section 92 agreement regarding inappropriate rendering of MBS items 23 and 91891 and prescribed pattern of phone services
Practitioner acknowledged inappropriate practice, agreed to repay $42,000 and be counselled by the Director
$42,000
General practitioner Section 92 agreement for excessive MBS billing
Practitioner agreed to repay $290,000 to the Commonwealth and disqualified from providing MBS items 965, 967, 92029, 92030 for 6 months
$290,000
Section 92 Agreement with General Practitioner for MBS Items 23, 5020, and 92210
Practitioner acknowledged inappropriate practice and agreed to repay $225,000 to the Commonwealth
$225,000
Agreement 1: General Practitioner (High-Prescriber)
Section 92 agreement with repayment
$120,000
Agreement 2: General Practitioner (High-Volume Services)
Section 92 agreement with repayment
$525,000
Agreement 4: General Practitioner (Multiple Services and High-Prescriber)
Section 92 agreement with repayment
$400,000
Agreement 16: General Practitioner (Diagnostic Ordering)
Section 92 agreement with repayment
$210,000
Final determination: PSRC 1396 - General Practitioner
Final determination with repayment and disqualification
$424,965
Final determination: General Practitioner 2 - Imaging
Final determination with repayment and disqualification
$340,000
Final determination: General Practitioner - Multiple Services
Final determination with repayment
$262,895
Final determination: General Practitioner - Mental Health
Final determination with repayment and disqualification
$140,000
Final determination: General Practitioner 1
Final determination with repayment and disqualification
$610,000
Final determination: General Practitioner - Multiple Items
Other / unclear
Not specified
Final determination: General Practitioner - Multiple Issues
Final determination with repayment and disqualification
$544,800
What survives review
Documentation has to stand alone
The note should show the presenting problem, assessment, clinical reasoning, time or complexity when relevant, and the plan without relying on memory.
Chronic disease management
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
Show the clinical input
For higher-value or repeated services, the record should make the practitioner contribution visible rather than just recording an administrative event.
Mental health treatment plan
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
Educational disclaimer
This educational module is based on publicly available PSR case-outcome material. It is general educational information only and does not constitute legal advice, billing advice, or a substitute for reviewing the MBS, PSR material, or obtaining professional advice.