Methods for Considering Conduct - Including Sampling

One approach the Committee can take in determining whether there has been inappropriate practice is to examine a sample of services. This approach may prove to be one of the most common, but Committee members should be aware of the other approaches that are available.

A Committee can request a sample based on a theme, such as a particular drug, a class of services or the location at which the service was provided. The sampling methodology the Committee uses must be either specified in a determination by the Minister or approved by an accredited statistician.

Another way the committee may proceed is to rely on patterns of services or the deeming provision in section 106KA. This provision is intended for cases where the PUR has rendered high daily volumes of services.

If the clinical or practice records of the PUR are missing, inadequate, illegible or otherwise incomprehensible, and it is impossible for the Committee to conduct an inquiry based on statistical sampling or patterns of services, the Committee can make a generic finding of inappropriate practice. This can be based on any information that it is able to obtain, including information supplied by Medicare Australia, contained in the report by the Director or given in evidence at hearings held by the Committee.

Finally, the Committee can proceed by considering the provision of specific services on a case-by-case basis.