Pressure fueled false HMR claims

EFFORTS to boost revenue for her employers have landed a Sydney-based pharmacist with an 18-month ban from the profession.

A NSW Civil and Administrative Tribunal found Surinder Kaur guilty of professional misconduct, over 126 false and or misleading claims to Medicare via the Sixth Community Pharmacy Agreement (6CPA) relating to Home Medication Reviews (HMRs) between 01 May 2015 and 12 Sep 2016.

The Tribunal heard that Kaur was not accredited to perform HMRs and had inappropriately used the identity of another pharmacist to submit claims, receiving $100 for each service.

Kaur was found to have inappropriately submitted several reports to patients’ GPs, using the other pharmacist’s name, confirming HMRs had been conducted, based on in-pharmacy reviews or discussions, which did not meet the requirements of the HMR program.

The Tribunal heard that Kaur acted in a false and or misleading manner on 26 Sep 2016 when she told her employer that she was accredited to carry out HMRs, despite knowing she was not.

During an interview with the Pharmacy Council of NSW on 19 Oct 2018 Kaur acted in a false and or misleading manner when she informed the Council that she had visited the homes of patients when carrying out the HMRs, in circumstances where the practitioner had not attended the homes of any patients, and also said that she had not received any financial advantage from her employer for the HMRs she had claimed for, the Tribunal heard.

Kaur told the Council that the majority of the HMR reports she had claimed for had not been the result of a GP referral.

She further conceded that many of the reviews would have constituted a MedsCheck, adding that she only visited the homes of patients who would have known her for years.

The Tribunal was told that Kaur had approached her employer to undertake reviews as a means of generating more income for the pharmacy, with Tribunal papers noting the store’s manager was “consistently and persistently urging pharmacy staff to increase revenue” and he was “complaining that the pharmacy was not meeting sales targets”.

However, the Tribunal noted that Kaur’s conduct could not be justified on the basis she was intending to help her employer.