Practitioner Review Program
Medicare Australia is responsible for the administration of Medicare and the Pharmaceutical Benefits Scheme (PBS). As part of these responsibilities, Medicare Australia may request the Director of Professional Services Review (PSR) to review the provision of services by practitioners who are suspected of engaging in inappropriate practice under the Health Insurance Act 1973 (the Act).
Medicare Australia identifies practitioners where Medicare or PBS data indicates that their rendering, initiating or prescribing practice profile appears different when compared with their peers. While this may reflect the nature of the practice, it may also indicate inappropriate practice. Identification and reviews of practitioners’ practice profiles protect patients and the community from the risks and costs of inappropriate practice.
Inappropriate practice can be defined as:
- conduct in connection with rendering or initiating services that would be unacceptable to the general body of members of that profession;
or - knowingly, recklessly or negligently causing or permitting a practitioner employed by a person or body corporate to engage in conduct that would be unacceptable to the general body of members of that profession.
Requests to the Director of Professional Services Review
The practitioner will be provided with an opportunity to make a submission for consideration by Medicare Australia prior to a request being made to the Director of PSR. Following consideration Medicare Australia may decide that:
- Medicare Australia’s concerns have been addressed and the matter will be closed;
or - Medicare Australia’s concerns have not been addressed and/or new concerns have been identified. In this case the practitioner will be referred to the Director of PSR.
Further information
Last updated: 25 November, 2008