MBS item scrutiny profile
MBS Item 44 — PSR scrutiny profile
Appears in 9 published determinations since 2024, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Inadequate documentation6
- Clinical appropriateness5
- Time based billing5
- Excessive servicing3
- After-hours billing2
- Mental health treatment plan2
- PBS prescribing2
- Prescribed pattern of services2
Specialties involved
- General Practice4
- Unknown4
- Mental Health1
Repayment range
Calculated only across the 9 published cases where a repayment amount is recorded.
Published cases mentioning item 44
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
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
General practitioner Section 92 agreement for MBS items 44 and 91891 and prescribed pattern of phone services
Practitioner acknowledged inappropriate practice, agreed to repay $23,000 and be counselled by the Director
$23,000
General practitioner Section 92 agreement for MBS items 44, 197, 91891 and prescribed pattern of services
Practitioner acknowledged inappropriate practice, agreed to repay $120,000 and be counselled by the Director
$120,000
Agreement 1: General Practitioner (High-Prescriber)
Section 92 agreement with repayment
$120,000
Agreement 6: Medical Practitioner (Surgical and Procedural Services)
Section 92 agreement with repayment
$209,000
Agreement 3: General Practitioner (Prescribed Pattern Issue)
Section 92 agreement with repayment
$760,000
Agreement 5: General Practitioner (High-Prescriber)
Section 92 agreement with repayment
$190,000
Agreement 14: General Practitioner (High-Frequency Services)
Section 92 agreement with repayment
$270,000
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.
Excessive servicing
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.