MBS item scrutiny profile
MBS Item 56223 — 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
- Inadequate documentation1
- Inappropriate Billing Practices1
Specialties involved
- General Practice1
- Unknown1
Repayment range
Calculated only across the 2 published cases where a repayment amount is recorded.
Published cases mentioning item 56223
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
Final determination: General Practitioner - Multiple Services
Final determination with repayment
$262,895
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.
Inappropriate Billing Practices
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.