Message from the Director
This content is prepared for employers, including corporate entities &/or their related officers, subject to a review under Part VAA of the Health Insurance Act 1973.
You or a corporate entity that you are involved with have been referred to me by a delegate of the Chief Executive Medicare. I have decided to conduct a review of services provided by practitioners employed or otherwise engaged by you or the corporate entity.
For the purposes of the Act, you or the corporate entity are referred to as a ‘person under review’. My role is to determine whether there are grounds on which a PSR Committee could reasonably conclude that you or your entity engaged in ‘inappropriate practice’ during a defined 12 month period by knowingly, recklessly or negligently causing or permitting a practitioner or practitioners to engage in conduct that constitutes ‘inappropriate practice’. The Committee would include peers from the profession or medical specialty relevant to field or fields of practice of the practitioners who rendered or initiated the services.
‘Inappropriate practice’ refers to conduct in connection with rendering or initiating Medicare Benefits Schedule (MBS) and/or Pharmaceutical Benefits Scheme (PBS) services that would be considered unacceptable to the general body of a practitioner’s peers.
My review will result in one of two possible outcomes:
- no further action or
- referral to a Committee of peers for further investigation.
A referral to a Committee can have significant outcomes. These can include a direction to repay Medicare benefits to the Commonwealth or, if you are a practitioner, disqualification of your ability to provide PBS services and/or some or all MBS services for a specified period. I strongly encourage you to seek legal advice and assistance about this process.
Particular queries in relation to my review should be directed to the staff members allocated to your review, as nominated in my correspondence. If you have any feedback in relation to your review, you can contact us at firstname.lastname@example.org.
To assist in ensuring that you have appropriate and relevant information available to help you understand the Scheme, I encourage you to review the information on this website.