MBS item scrutiny profile
MBS Item 599 — PSR scrutiny profile
Appears in 3 published determinations since 2023, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- After-hours billing2
- Excessive servicing2
- Clinical appropriateness1
- Inadequate documentation1
- Inappropriate Billing Practices1
- MBS requirement breach1
- Telehealth compliance1
- Time based billing1
Specialties involved
- General Practice1
- Other1
- Unknown1
Repayment range
Calculated only across the 3 published cases where a repayment amount is recorded.
Published cases mentioning item 599
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
Agreement 3: General Practitioner (Prescribed Pattern Issue)
Section 92 agreement with repayment
$760,000
Agreement 2: Medical Practitioner (Afterhours Services)
Section 92 agreement with repayment
$560,000
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.
Excessive servicing
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.
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.
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.