Health Care Complaints Commission v Flekser [2016] NSWCATOD 1

Health Care Complaints Commission v Flekser [2016] NSWCATOD 1

The Tribunal was comfortably satisfied that Particulars 1, 2, 4 and 6 were established: Dr Flekser engaged in a deliberate system of false billing, claimed and received payments from Medicare and private health funds to which he was not entitled, knowingly claimed for private patient operations at St George Hospital...

Source-derived case information.

Jurisdiction
Australia
Judgment Date
19 January 2016
Procedural Posture
Disciplinary Complaints Concerning a Medical Practitioner in the Occupational Division of the Civil and Administrative Tribunal of New South Wales / Principal Judgment on Whether Unsatisfactory Professional Conduct and Professional Misconduct Were Established; Consequential Orders Deferred for Directions
Outcome
Complaint of unsatisfactory professional conduct established for Particulars 1, 2, 4 and 6; conduct separately and cumulatively held to constitute professional misconduct; matter listed for further directions on consequential orders.
Legal Topics
['unsatisfactory Professional Conduct' 'professional Misconduct' 'medical Billing' 'medicare and Private Health Fund Claims' 'right of Private Practice' 'professional Honesty' 'standard of Proof']
['health Practitioner Regulation' 'professional Discipline'] ['unsatisfactory Professional Conduct' 'professional Misconduct' 'medical Billing' 'medicare and Private Health Fund Claims' 'right of Private Practice' 'professional Honesty' 'standard of Proof']

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Procedural Posture

Disciplinary Complaints Concerning a Medical Practitioner in the Occupational Division of the Civil and Administrative Tribunal of New South Wales / Principal Judgment on Whether Unsatisfactory Professional Conduct and Professional Misconduct Were Established; Consequential Orders Deferred for Directions

Legal Issues

  1. 1 ['Whether the practitioner claimed and received fees for assistance at St George Hospital operations knowing that he had not provided assistance.' 'Whether the practitioner claimed and received fees for assistance at St George Private Hospital operations knowing that he had not provided assistance.' 'Whether the practitioner submitted an application for a provider number for St George Hospital knowing that he did not hold a right of private practice.' 'Whether the practitioner claimed and received fees for private patient operations at St George Hospital knowing that he did not hold a right of private practice.' 'Whether the practitioner failed to apply for leave without pay from St George Hospital when claiming and receiving fees for assistance in operations at St George Private Hospital.' 'Whether the practitioner knowingly made or caused false entries in the Australian Vascular Audit that he knew would be submitted in support of accreditation as a vascular surgeon.' 'Whether the established conduct amounted to unsatisfactory professional conduct and, cumulatively, professional misconduct.']

Ratio Decidendi

The Tribunal was comfortably satisfied that Particulars 1, 2, 4 and 6 were established: Dr Flekser engaged in a deliberate system of false billing, claimed and received payments from Medicare and private health funds to which he was not entitled, knowingly claimed for private patient operations at St George Hospital without a right of private practice, and used false Australian Vascular Audit entries in a way that could compromise the audit system. Particulars 3 and 5 were not established. The established conduct amounted to unsatisfactory professional conduct and, when considered cumulatively with the Tribunal's findings about dishonesty and untruthfulness, constituted professional...

Court Disposition

Complaint of unsatisfactory professional conduct established for Particulars 1, 2, 4 and 6; conduct separately and cumulatively held to constitute professional misconduct; matter listed for further directions on consequential orders.

Orders

  • ['Complaint of unsatisfactory professional conduct established in relation to Particulars 1, 2, 4, and 6.' 'Conduct considered separately and cumulatively held to constitute professional misconduct.' 'Case listed for further Directions regarding consequential orders.']