MBS item scrutiny profile
MBS Item 5040 — PSR scrutiny profile
Appears in 8 published determinations since 2024, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- After-hours billing3
- Inadequate documentation3
- Clinical appropriateness2
- Mental health treatment plan2
- Chronic disease management1
- Excessive billing1
- Inadequate clinical service delivery1
- Inadequate Documentation1
Specialties involved
- Unknown5
- General Practice3
Repayment range
Calculated only across the 8 published cases where a repayment amount is recorded.
Published cases mentioning item 5040
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 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 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 with General Practitioner for Inappropriate Billing and Prescribing
Practitioner acknowledged inappropriate practice; agreed to repay $400,000; reprimanded and counselled by Associate Director; disqualified from providing certain MBS items for 12 months
$400,000
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
Agreement 1: General Practitioner (High-Prescriber)
Section 92 agreement with repayment
$120,000
Final determination: General Practitioner - Multiple Services
Final determination with repayment
$262,895
Final determination: General Practitioner 1
Final determination with repayment and disqualification
$610,000
What survives review
After-hours billing
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
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.
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.