Director's Actions following the Review

Detailed information on the PSR scheme is published in the document Your Guide to the PSR Process

After the Director's review of the provision of services by the PUR, the Director must either:

decide to take no further action under section 91; or
give the PUR a report explaining why the Director has not proceeded under section 91 and invite him or her to make written submissions within 1 month about the action the Director should take in relation to the review.

As soon as practicable after taking into account any submissions received, the Director must decide whether to:

take no further action in relation to the review under section 91; or
enter into an agreement with the PUR under section 92; or
make a referral to a Committee under section 93.

The Director has 12 months to decide whether to take no further action on the review, enter into an agreement with the PUR or refer the matter to a Committee. If the Director has decided to conduct a review, but has not taken any of those steps within 12 months, the review will lapse. The 12 month period can be suspended in some circumstances, including where there is an injunction or other court order.

Taking no further action

To take no further action on a review under section 91, the Director must be satisfied that:

there are insufficient grounds on which a Committee could reasonably find that the PUR has engaged in inappropriate practice when providing services during the review period; or
circumstances exist that would make a proper investigation by a Committee impossible.

Within seven days of deciding to take no further action on a review, the Director must give Medicare Australia and the PUR written notice of the decision. The Director must also provide them with a report setting out the grounds for that decision.

Entering into an Agreement and its consequences

The Director and the PUR can enter into a written agreement under which the PUR acknowledges that he or she engaged in inappropriate practice in connection with rendering or initiating specified services during the review period. If the PUR does this, the agreement will include the action that will be taken in relation to them. This may include a reprimand, repayment of amounts equal to Medicare benefits paid, suspension of authority to prescribe and partial or full disqualification from Medicare for up to 3 years.

Any such agreement must be ratified by the Determining Authority (DA) to take effect. If the agreement is not ratified by the DA, the Director has 3 months to decide to:

take no further action in relation to the review under section 91; or
enter into a further agreement with the PUR; or
make a referral to a Committee under section 93.

If the Director has not made a decision by the end of those 3 months, the Director is required to make a referral to a Committee.

The Director must not disclose to any Panel member (other than a Panel member the Director may have consulted to obtain assistance in making a decision) any communications between the PUR and the Director concerning a proposed agreement. This restriction applies even if the agreement is not ratified by the DA and the matter is then referred to a committee. Panel members consulted by the Director in this way cannot be appointed as a Committee member.

Referral to a Committee

If the Director does not decide to take no further action in relation to the review and does not enter into an agreement with the PUR, the Director may set up a Committee and make a referral to it.

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