Determining Authority
Determining Authority – Division 5 of Part VAA of the Health
Insurance Act 1973
The Determining Authority is an independent body within the Professional
Services Review Scheme and is established by section 106Q of the Health
Insurance Act 1973 (the Act). It has two main roles.
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The first is to decide whether or not to ratify agreements reached
between the Director of PSR and a person under review on the sanctions to apply where both parties agree that inappropriate
practice has occurred.
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The second is to determine the sanctions to apply whenever
practitioners have been found by a Professional Services Review Committee
to have engaged in inappropriate practice.
The Determining Authority comprises a permanent chair (medical practitioner),
a permanent lay person and a member who represents the profession of
the PUR (section 106ZPA). The Minister for Health and Ageing appoints
the Chair and members after consultation with the Australian Medical
Association and the relevant professions.
The sanctions, or directions, which the Determining Authority may impose
or ratify are set out in section 106U of the Act. These include:
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a reprimand by the Director of PSR or the Director’s nominee
(section 106U(1)(a));
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counselling by the Director of PSR or the Director’s nominee
(section 106U(1)(b);
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repayment of the whole or part of any Medicare benefit in respect
of which the person under review has been found to have engaged in
inappropriate practice (section 106U(1)(ca);
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revocation or suspension of the authority to prescribe or dispense
where the person under review has been found to have engaged in inappropriate
practice involving prescribing or dispensing a pharmaceutical
benefit (section 106U(1)(f));
and
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full or partial disqualification from Medicare for periods of up
to three years (section 106U(1)(g).
Upon receipt of an agreement between the Director
of PSR and a person under review, the Determining Authority has one
month to either ratify or refuse to ratify that agreement (section 106R(1).
Failure to make a decision within this time period results in the agreement
automatically being ratified (section 106R(2).
When the Determining Authority receives a PSR Committee report containing
a finding of inappropriate practice, within a month it
will provide the person under review with a written invitation to make
written submissions about the directions the Determining Authority
should make as a result of the report (section 106SA). The Determining
Authority then has a further month in which to make
a draft determination and give copies of that draft determination to
the person under review and the Director of PSR (section 106T(1). In
giving the draft determination to the person under review, the Determining
Authority must offer the person under review the opportunity to make
written submissions,
within a period of 14 days after receiving the draft determination,
suggesting changes to the directions contained in the
draft determination (section 106T(2)).
The Determining Authority must take any submissions received into account
in making its final determination which must be made within one month
after the end of the 14 day period allowed (section 106TA(1)). However,
failure by the Determining Authority to comply with these time limits
does not affect the validity of either draft or final determinations
(sections 106T(4) and 106TA(2)).
Should the Determining Authority develop concerns that a practitioner’s
referred conduct may either constitute a significant threat to the life
or health of a person or not comply with the professional standards
of that profession, it may refer those concerns to the Director of Professional
Services Review (sections 106XA and 106XB) for forwarding to the appropriate
body.
Although the Director of Professional Services Review provides administrative
and other support services to the Determining Authority, the Authority
remains totally independent of the Director in performing its statutory
functions.
Any enquiries about the Determining Authority may be directed to the
Manager on telephone (02) 6120 9155 or facsimile (02) 6120 9180.
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