GP to repay $143,000 to Medicare after MBS item confusion

Two GPs that claimed a $114 MBS item restricted to ENT specialists for a process to manually clean an ear, have been required to repay more than $143,000 to Medicare.

The MBS item 41647 covers the use of an operating microscope for a micro-inspection of the tympanic membrane.

However, the description of the MBS item begins with 'ear toilet' recognising that the ear must be firstly cleaned.

Professor Julie Quinlivan, Director of Professional Services Review, explained that this description led the GPs to misjudge the MBS item code, and concluding they could utilise it for earwax removal if they used a microscope.

Prof Quinlivan further stated that, “[But] this was a particular item that was there for people who have a medical condition that requires micro-inspection of the tympanic membrane …”

“It’s not really appropriate if you want to clean wax out of the ear.”

After a Professional Services Review had been carried out, both of the GPs understood they had incorrectly used the MBS item code.

One of the two GPs was required to pay Medicare $110,000, as they had wrongly co-claimed the MBS item with a standard consultation.

The second GP had to repay $33,355, of which included the misuse of long consultation and telehealth items.

Prof Quinlivan clarified that she had done as much as possible to reduce the penalties imposed on both GPs, as they had both sincerely misinterpreted the item code.

Prof Quinlivan said, “I displayed the maximum degree of mitigation that I could.” 

She added, “For years and years, GPs have been removing ear wax, and different GPs do it in different ways … but under the MBS, the way they are remunerated is for their time using standard consultation items.” 

“If it’s a really difficult one, and it takes you longer, you charge a long consultation.” 

However, Prof Quinlivan believed the MBS item was not likely to confuse GPs in the future, due to the description of the item being amended, specifying it was only to be used for patients requiring a micro-inspection of the tympanic membrane.

Prof Quinlivan also said the MBS explanatory notes would also be sure to acknowledge the item code was not to be used for removal of wax from the ears.