MBS item scrutiny profile
MBS Item 721 — PSR scrutiny profile
Appears in 27 published determinations since 2021, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Inadequate documentation19
- Chronic disease management17
- Clinical appropriateness13
- MBS requirement breach11
- Excessive servicing8
- Mental health treatment plan7
- PBS prescribing6
- After-hours billing3
Specialties involved
- General Practice17
- Unknown10
Repayment range
Calculated only across the 27 published cases where a repayment amount is recorded.
Published cases mentioning item 721
Section 92 agreement with General Practitioner over phone-pattern and chronic disease management claims
Practitioner agreed to repay $326,000, be reprimanded and counselled by the Director, and be disqualified from providing certain MBS items for 12 months
$326,000
Section 92 Agreement with General Practitioner for Excessive MBS Item Rendering
Practitioner agreed to repay $288,492, was reprimanded and counselled by the Associate Director, and disqualified from providing certain MBS services for 24 months
$288,492
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 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 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 MBS Item Use
Practitioner agreed to repay $240,000 to the Commonwealth; disqualified from providing MBS items 699, 705, 965, 967, 92029, 92030 for 12 months; disqualified from providing MBS item 30192 for 6 months
$240,000
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
Section 92 agreement with General Practitioner for MBS item concerns
Practitioner acknowledged inappropriate practice; agreed to repay $178,000; counselled by Director; disqualified from providing MBS items 965, 967, 92029, 92030 for 9 months
$178,000
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
Agreement 16: General Practitioner (Diagnostic Ordering)
Section 92 agreement with repayment
$210,000
Agreement 2: General Practitioner (High-Volume Services)
Section 92 agreement with repayment
$525,000
Agreement 5: General Practitioner (Multiple Services)
Section 92 agreement with repayment
$319,000
Agreement 4: General Practitioner (Team Care Arrangements)
Section 92 agreement with repayment
$270,000
Agreement 3: General Practitioner (CDM Services)
Section 92 agreement with repayment
$57,000
Agreement 7: General Practitioner (Mental Health and Diagnostic Services)
Section 92 agreement with repayment
$611,000
Agreement 1: General Practitioner (High-Prescriber)
Section 92 agreement with repayment
$400,000
Agreement 8: General Practitioner (CDM Management)
Section 92 agreement with repayment
$100,000
Agreement 1: Medical Practitioner (High-Volume Services)
Section 92 agreement with repayment
$200,000
Agreement 4: General Practitioner (Volume-Based Issues)
Section 92 agreement with repayment
$245,000
Final determination: PSRC 1396 - General Practitioner
Final determination with repayment and disqualification
$424,965
Agreement 2: General Practitioner
Section 92 agreement with repayment
$75,000
Agreement 5: General Practitioner
Section 92 agreement with repayment
$130,000
Final determination: General Practitioner 1
Final determination with repayment and disqualification
$610,000
Final determination: General Practitioner - Multiple Issues
Final determination with repayment and disqualification
$544,800
Final determination: General Practitioner - Mental Health
Final determination with repayment and disqualification
$140,000
Final determination: General Practitioner - Health Assessments
Final determination with repayment and disqualification
$262,500
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.
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.
MBS requirement breach
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.