Overview/Description

The PSR Scheme (the Scheme) gives the Professional Services Review (PSR) authority to investigate whether health practitioners have engaged in inappropriate practice when providing Medicare services or when prescribing medication.

[Note: The Professional Services Review Scheme, including the Review process, is set out in the provisions of the Health Insurance Act 1973].

The Scheme provides the legislative framework within which the Director of PSR (Director) reviews the provision of services by a practitioner in response to a request by Medicare Australia. This could be in connection with Medicare and/or the Pharmaceutical Benefits Scheme (PBS), both of which are administered by Medicare Australia.

Health practitioners covered by the Scheme include medical and dental practitioners, podiatrists, chiropractors, physiotherapists and optometrists.

After completion of the review, the Director must:

• decide to take no further action
• negotiate and enter into an agreement, or
• establish a Professional Services Review Committee (PSRC) and make a referral to it with respect to the Person Under Review (PUR).

The PSRC consists of medical practitioners and other health practitioners appointed by the Minister for Health after consultation with the AMA or appropriate professional organisations.

The decision of the Director, or the PSRC, is then referred to the Determining Authority to determine sanctions to be applied to the PUR. The Determining Authority comprises a medical practitioner as Chair, plus a layperson and a member of the relevant profession. They are appointed by the Minister after consultation with the appropriate professions.

A more detailed overview of the PSR Scheme can be found in the PSR Scheme Booklet.