Agency overview
The PSR Scheme
Medicare Australia requests to review
Medicare Australia asks the Director of PSR to review a practitioner’s provision of services if it considers he or she may have provided those services inappropriately based on statistical data and other information.
Medicare Australia has access to claims data and any information elicited by a medical adviser during a visit to a practitioner or from a practitioner’s written submissions. The reasons Medicare Australia seeks review of the provision of services generally fall within distinct categories, including:
- prescribed pattern of services
- high volume of services
- high number of services per patient
- high prescribing of Pharmaceutical Benefits Scheme (PBS) drugs
- inadequate clinical input
- Medicare Benefits Schedule (MBS) item not satisfied
- services not medically necessary.
Table 3 summarises the issues PSR has identified in requests to review this year.
Cases of possible fraud PSR identifies in the course of its investigations are referred back to Medicare Australia for action.