MBS item scrutiny profile
MBS Item 91891 — PSR scrutiny profile
Appears in 14 published determinations since 2024, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Inadequate documentation5
- MBS requirement breach4
- PBS prescribing4
- Telehealth compliance4
- Excessive servicing3
- Prescribed pattern of services3
- Time based billing3
- Clinical appropriateness2
Specialties involved
- Unknown10
- General Practice4
Repayment range
Calculated only across the 14 published cases where a repayment amount is recorded.
Published cases mentioning item 91891
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 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
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 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
Section 92 agreement regarding inappropriate rendering of MBS items 23 and 91891 and prescribed pattern of phone services
Practitioner acknowledged inappropriate practice, agreed to repay $42,000 and be counselled by the Director
$42,000
General practitioner Section 92 agreement for MBS items 44, 197, 91891 and prescribed pattern of services
Practitioner acknowledged inappropriate practice, agreed to repay $120,000 and be counselled by the Director
$120,000
General practitioner Section 92 agreement for MBS items 44 and 91891 and prescribed pattern of phone services
Practitioner acknowledged inappropriate practice, agreed to repay $23,000 and be counselled by the Director
$23,000
Section 92 Agreement for General Practitioner - MBS Items 36, 91891, 92210
Practitioner agreed to repay $340,000, was reprimanded by Associate Director, and disqualified from providing MBS item 92210 services for 12 months
$340,000
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 MBS item 91891 and PBS item 8254K
Practitioner acknowledged inappropriate practice, agreed to repay $180,000 and be counselled by Associate Director
$180,000
Agreement 8: General Practitioner (Opioid Prescriber with Pattern Issues)
Section 92 agreement with repayment
$73,500
Agreement 4: General Practitioner (Multiple Services and High-Prescriber)
Section 92 agreement with repayment
$400,000
Agreement 7: General Practitioner (Telehealth High-Volume with Pattern Issues)
Section 92 agreement with repayment
$165,000
Agreement 13: General Practitioner (Opioid and Benzodiazepine Prescriber with Pattern Issues)
Section 92 agreement with repayment
$295,000
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.
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.
PBS prescribing
Keep the source record clear enough for an external peer to connect the patient need, the service provided, and the item claimed.
Telehealth compliance
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.