PSR was established in July 1994 as an Agency within the Health Portfolio to protect the integrity of Medicare and the PBS. Part VAA of the Health Insurance Act 1973 establishes the agency, sets out its role and powers and the process that it must follow when conducting its work.
Through the performance of its statutory role, PSR protects patients and the community from the risks associated with inappropriate practice, and protects the Commonwealth from having to meet the cost of medical / health services provided as a result of inappropriate practice.
In its administration of the Scheme, PSR is responsible for reviewing and examining possible inappropriate practice by practitioners when they provide Medicare services or prescribe Government subsidised medicines under the PBS. PSR examines suspected cases of inappropriate practice which have been referred by delegates of the Chief Executive Medicare. PSR cannot initiate its own reviews of a practitioner.
Under the PSR Scheme there is a two-pronged approach to safeguard the integrity of the Medicare program and the PBS. This involves protecting the public from:
- inappropriate practice, by ensuring that the Commonwealth funded services delivered by practitioners are medically necessary and clinically relevant
- the consequences of inappropriate practice, by ensuring that payments to claimants are made in accordance with the regulations for the Medicare and Pharmaceutical Benefit schedules.
The PSR process is comprised of three main stages:
- The first stage involves the consideration by the Director of PSR of whether a practitioner might have engaged in inappropriate practice.
- The second stage is a peer review process by a PSR Committee to determine whether the practitioner did engage in inappropriate practice.
- The third and final stage involves the consideration and determining of an appropriate outcome by the Determining Authority.