Findings and Reporting by the Committee

Committee Findings

The Committee can make findings only in respect of services specified in the referral. Committees must work within this limitation.

Under subsection 106H(3) the Committee's investigation is not limited by the reasons or anything else in the Director's report to the Committee or by any request under section 86 (from Medicare Australia) or section 106J (where a Committee requests the Director to review the provision of services).

Subsection 106H(3) is particularly important. It makes clear that the Committee is able to investigate other matters related to the referred services, not previously identified, which arise during the course of its investigation of the referred services. But these 'other matters' must still relate to whether there has been inappropriate practice in relation to the provision of Medicare or PBS services.

If it appears to the Committee that the PUR may have engaged in inappropriate practice in the provision of services that fall outside the scope of the referral, the Committee can request the Director to review the provision of those services.

Reporting by the Committee

At the close of the hearing and while the Committee is preparing its draft report, the Committee may choose to invite the PUR to provide the Committee (within a specified timeframe) with further information the PUR wishes to be taken into account.

The Committee will prepare a draft report of its preliminary findings setting out its reasons for those findings. A copy of the draft report must be given to the PUR, with an invitation to make submissions suggesting changes to the draft report.

The PUR may, within 1 month, make submissions in relation to the draft report. The committee must consider those submissions.

If the draft report does not contain a finding of inappropriate practice, the draft report will become the final report of the Committee and will be distributed to the PUR, the Director and HIC. A notice must also be provided with the report stating that the report is the final report, that it does not contain a finding of inappropriate practice and that no further action will be taken as a result.

If the draft report contains a finding of inappropriate practice, the Committee will prepare a final report after taking into account any submissions made by the PUR. The final report must not contain a finding of inappropriate practice unless the finding and the reasons for that finding were included in the draft report. The report must be given to the PUR and the Director and will later be provided to the Determining Authority (DA).

If the PUR is a practitioner the final report may, with their consent, include recommendations for the practitioner to be disqualified from Medicare and about the nature and period of the disqualification. Note: these recommendations will not bind the DA. They may still make any of the directions available to them under s 106U.

The PUR has 28 days to seek judicial review in the Federal Court. The final report will be sent to the DA 1 month after it was provided to the PUR.

Under section 106G the Committee must ensure the whole process, from receipt of the referral to giving the final report to the DA, is completed within 6 months.

The Committee may seek approval from the Director to extend this period by 3 months at a time. In addition, the 6 month period is, by force of a determination made by the Committee for this purpose, extended for any period during which the PUR is unable, because of illness, to attend a Committee hearing or for any period during which the PUR or another person fails to comply with a notice to produce documents. Where the Committee process has been stalled by Court proceedings, it will be necessary to obtain extensions from the Director.

Referral of Issues to Regulatory or Professional Bodies

If a Committee considers that conduct by a PUR has caused, is causing or is likely to cause, a significant threat to the life or health of any person, the Committee must give the Director a written statement of its concerns under section 106XA of the Act. The Director must take the appropriate action upon receipt of such a statement from the Committee.

Similarly if the Committee becomes aware of an issue that it considers to be of concern to the profession of which the PUR is a member, or believes that the PUR has breached a professional standard, the Committee must notify the Director and give details of the matter about which they are concerned. The Director must forward this information and any relevant material to HIC or another appropriate body nominated in the regulations.

Fraud

If the Committee suspect the PUR has committed a criminal offence against the Commonwealth, it can send relevant material to the Director for referral to HIC for investigation but may otherwise continue with its consideration of the referral.