MBS item scrutiny profile
MBS Item 92028 — PSR scrutiny profile
Appears in 8 published determinations since 2022, with related issues and repayments shown only where recorded.
Scrutiny profile
Co-occurring issue categories
- Chronic disease management6
- Inadequate documentation6
- Clinical appropriateness4
- Excessive servicing4
- MBS requirement breach4
- Inappropriate billing and documentation1
- Prescribed pattern of services1
- Time based billing1
Specialties involved
- General Practice6
- Unknown2
Repayment range
Calculated only across the 8 published cases where a repayment amount is recorded.
Published cases mentioning item 92028
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 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 2: General Practitioner (High-Volume Services)
Section 92 agreement with repayment
$525,000
Agreement 16: General Practitioner (Diagnostic Ordering)
Section 92 agreement with repayment
$210,000
Agreement 8: General Practitioner (CDM Management)
Section 92 agreement with repayment
$100,000
Agreement 3: General Practitioner (CDM Services)
Section 92 agreement with repayment
$57,000
Agreement 5: General Practitioner (Multiple Services)
Section 92 agreement with repayment
$319,000
Agreement 4: General Practitioner (Volume-Based Issues)
Section 92 agreement with repayment
$245,000
What survives review
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.
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.
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.
Excessive servicing
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.