MBS item scrutiny profile
MBS Item 91801 — PSR scrutiny profile
Appears in 5 published determinations since 2024, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Clinical appropriateness2
- Inadequate documentation2
- Time based billing2
- After-hours billing1
- Excessive servicing1
- Inadequate Documentation1
- Inappropriate billing and documentation1
- Incorrect item use1
Specialties involved
- General Practice3
- Unknown2
Repayment range
Calculated only across the 4 published cases where a repayment amount is recorded.
Published cases mentioning item 91801
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
Agreement 1: General Practitioner (High-Prescriber)
Section 92 agreement with repayment
$120,000
Agreement 14: General Practitioner (High-Frequency Services)
Section 92 agreement with repayment
$270,000
Final determination: General Practitioner - Multiple Items
Other / unclear
Not specified
What survives review
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.
Time based billing
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
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.
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.