Determining Authority
Detailed information on the PSR scheme is published in the document Your Guide to the PSR Process
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.
-
The
first is to decide whether or not to ratify agreements reached
between the Director of PSR and a person under review (PUR) on the sanctions
to apply where both parties agree that inappropriate practice has
occurred.
-
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 person under review (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:
-
a reprimand by the
Director of PSR or the Director’s nominee (section 106U(1)(a));
-
counselling by the
Director of PSR or the Director’s nominee (section 106U(1)(b);
-
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);
-
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
-
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 inquiries about the Determining Authority may
be directed to the Secretariat on telephone (02) 6120 9155, facsimile
(02) 6120 9180 or email: determining.authority@psr.gov.au
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