MBS item scrutiny profile
MBS Item 5043 — PSR scrutiny profile
Appears in 2 published determinations since 2024, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- After-hours billing1
- Chronic disease management1
- Clinical appropriateness1
- Excessive billing of MBS items1
- Inadequate documentation1
- Mental health treatment plan1
Specialties involved
- General Practice1
- Unknown1
Repayment range
Calculated only across the 2 published cases where a repayment amount is recorded.
Published cases mentioning item 5043
Section 92 agreement with General Practitioner for excessive MBS item billing and inappropriate practice
Practitioner agreed to repay $400,000, be reprimanded and counselled by Associate Director, and disqualified from providing MBS item 707 services for 24 months
$400,000
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.
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.
Tie the note back to the descriptor
The record should show the facts that made the item available, including patient status, service content, timing and any required review cycle.
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.