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Qld GP ordered to repay $780,000 in 'fictitious' Medicare claims

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A Queensland GP ordered to repay $780,000 in Medicare rebates had “incomprehensible” medical records and investigators believe he “rendered some services improperly or fictitiously”.

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Dr Hector Mario Urbina, or Marsden, has been reprimanded and counselled by the Professional Services Review and directed to repay $779,878.05 to the Commonwealth.

Urbina, who graduated from the University of Queensland in 2000, was also disqualified from billing five specific Medicare item numbers for three years, another two for 18 months, one for 12 months and one for six months.

The PSR, a statutory agency that acts on referrals from Medicare, engaged a committee of peers to review Urbina’s work and agreed there had been an “extremely serious level of inappropriate practice”.

“The Committee was concerned with the highly unusual structure of the practitioner’s medical records, which it found to be incomprehensible and made it near impossible for another practitioner relying on the record to effectively take over ongoing care of his patients,” the PSR reported.

“The Committee was otherwise concerned with the practitioner’s inadequate record keeping, lack of clinical indication for services, clinical decision-making, and failure to comply with MBS requirements.  The Committee was particularly concerned that the practitioner had rendered some services improperly or fictitiously.”

Urbina, one of the first doctors to be named under a new PSR policy of disclosure, could not be contacted. According to a regulatory database, his registration is unconditional and due for renewal in September.

The PSR routinely orders or negotiates repayments from doctors under Federal Government measures designed to ensure patients and Medicare funds are protected.

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