Australian radiologist to repay $3.6M over Medicare claims

An Australian diagnostic radiologist has agreed to repay $3.6M to the Commonwealth after a Professional Services Review investigation found inappropriate practice linked to multiple Medicare Benefits Schedule items.

The case was disclosed in the PSR Director’s March 2026 update, published April 23. The unnamed practitioner was in the top 1% of providers for services billed under 88 individual MBS items and was the highest-ranked provider for 7 individual items, according to PSR.

The reviewed items included initial and subsequent specialist attendances, continuous infusion or injection to maintain regional anesthesia or analgesia, abdominal and pelvic ultrasound, musculoskeletal ultrasound, CT performed with an interventional procedure, CT coronary angiography, and orthopantomography.

PSR said it had concerns about the practitioner’s billing and reporting arrangements, including whether the general body of radiologists would consider the arrangements inappropriate. The agency also cited an unusually high volume of services, including personal attendances at many geographically dispersed sites, raising questions about whether MBS requirements could always be met.

Clinical involvement was also unclear in many cases. PSR said services were sometimes performed and reported by other practitioners but signed by the radiologist under review.

Referral handling was another issue. Where requests were made for specific services, alternative services were often provided, and the records did not show why the alternative service was performed or whether the requesting practitioner had been consulted, according to PSR.

The agency also reported concerns about supervision for several imaging items, including abdominal ultrasound, pelvic ultrasound, musculoskeletal ultrasound, and CT coronary angiography. In some cases, records did not make clear that the practitioner personally attended patients for musculoskeletal ultrasound services.

Record-keeping problems were cited across the review. PSR said complete records could not be efficiently accessed and extracted, and some records did not contain valid referrals for specialist attendances or show that a consultation occurred separately from a procedure.

The practitioner acknowledged inappropriate practice in connection with 10 MBS items. The agreement requires repayment of $3.6M, a reprimand, counseling, and a 12-month disqualification from providing several specialist attendance and telehealth items.

The outcome was part of 20 section 92 agreements that came into effect in March 2026, according to PSR. Section 92 agreements allow the PSR Director and a person under review to resolve matters through agreed outcomes.