MBS item scrutiny profile
MBS Item 36 — PSR scrutiny profile
Appears in 24 published determinations since 2023, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Inadequate documentation16
- Clinical appropriateness11
- Time based billing11
- MBS requirement breach7
- Mental health treatment plan7
- PBS prescribing7
- After-hours billing6
- Telehealth compliance6
Specialties involved
- General Practice15
- Unknown8
- Mental Health1
Repayment range
Calculated only across the 23 published cases where a repayment amount is recorded.
Published cases mentioning item 36
Section 92 Agreement with General Practitioner for Excessive and Inappropriate MBS Item Use
Practitioner agreed to repay $240,000 to the Commonwealth; disqualified from providing MBS items 699, 705, 965, 967, 92029, 92030 for 12 months; disqualified from providing MBS item 30192 for 6 months
$240,000
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 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 for General Practitioner - MBS Items 36, 91891, 92210
Practitioner agreed to repay $340,000, was reprimanded by Associate Director, and disqualified from providing MBS item 92210 services for 12 months
$340,000
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
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 over prescribed pattern of phone services and health assessments
Practitioner acknowledged inappropriate practice; agreed to repay $350,000; reprimanded; disqualified from certain MBS items for 6 to 12 months
$350,000
Section 92 agreement with General Practitioner over templated records and mental health plan claims
Practitioner acknowledged inappropriate practice; agreed to repay $700,000; reprimanded and counselled by Associate Director; disqualified from providing certain MBS items for 6 to 12 months
$700,000
Agreement 6: Medical Practitioner (Surgical and Procedural Services)
Section 92 agreement with repayment
$209,000
Agreement 4: General Practitioner (Residential Aged Care Services)
Section 92 agreement with repayment
$400,000
Agreement 1: General Practitioner (High-Prescriber)
Section 92 agreement with repayment
$120,000
Agreement 3: General Practitioner (Prescribed Pattern Issue)
Section 92 agreement with repayment
$760,000
Agreement 7: General Practitioner (Telehealth High-Volume with Pattern Issues)
Section 92 agreement with repayment
$165,000
Agreement 14: General Practitioner (High-Frequency Services)
Section 92 agreement with repayment
$270,000
Agreement 8: General Practitioner (Opioid Prescriber with Pattern Issues)
Section 92 agreement with repayment
$73,500
Agreement 4: General Practitioner (Multiple Services and High-Prescriber)
Section 92 agreement with repayment
$400,000
Agreement 1: General Practitioner (High-Prescriber)
Section 92 agreement with repayment
$400,000
Agreement 5: General Practitioner (Multiple Services)
Section 92 agreement with repayment
$319,000
Final determination: General Practitioner 1
Final determination with repayment and disqualification
$610,000
Final determination: General Practitioner - Brief Consultations
Final determination with repayment
$15,000
Final determination: General Practitioner - Multiple Services
Final determination with repayment
$262,895
Final determination: General Practitioner - Multiple Issues
Final determination with repayment and disqualification
$544,800
Final determination: General Practitioner - Mental Health
Final determination with repayment and disqualification
$140,000
Final determination: General Practitioner - Multiple Items
Other / unclear
Not specified
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.
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.
Time based billing
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
MBS requirement breach
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.