3. Case descriptions
Decisions to take no further action
The Director can, after considering all the relevant material, decide to dismiss a case and take no further action under section 91 of the Health Insurance Act 1973. Over the last four years the Director has dismissed approximately 15 per cent of Medicare Australia’s requests to review.
The practitioners dismissed under section 91 have had similar statistical profiles to others referred for review. Medicare billing data for most of these practitioners has been at or above the 99th percentile compared to their peers and they have not changed their behaviour since Medicare Australia’s earlier interventions.
The Director reviews a case to determine whether there is sufficient evidence for a PSR Committee to make a finding of inappropriate practice. The practitioner’s medical records in the cases dismissed have been at a standard that the general body of peers would consider appropriate. The records were well maintained with allergies, past history and medication kept up to date. The records provided evidence that the particular MBS item descriptor had been met. The record keeping would allow another practitioner to take over the care of a patient and have an understanding of what had occurred in previous consultations.
The Director meets with all practitioners before making a final decision. At this meeting the Director gains an understanding of some of the practitioner’s motivations and their insight into their own behaviour. Most practitioners whose cases were dismissed had been working long hours, often seven days per week, and had little life outside their practice. Several said they ‘love going to work’ and do not have any other interests. Discussion of these issues has been a watershed for some practitioners who have used the PSR process to critically examine the choices they have made.
Protection of the public is a central tenet of PSR’s role. All practitioners dismissed under section 91 had been practising at a high standard while working much longer hours than their peers. In 2008–09 the Director decided to take no further action in relation to 19 practitioners.