Message from the Director
I have received a request from a delegate of the Chief Executive Medicare and have decided to review your provision of services under Part VAA of the Health Insurance Act 1973.
My role is to determine whether there are grounds on which a Committee of your peers could reasonably conclude that you engaged in ‘inappropriate practice’ during a defined 12 month period. ‘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 your peers.
My review will result in one of three possible outcomes:
- no further action
- the negotiation of an agreement, which will require you to acknowledge that you engaged in inappropriate practice in connection with rendering or initiating MBS items or PBS items and can involve other specified action as appropriate or
- referral to a Committee of your peers for further investigation.
An agreement or referral to a Committee can have significant outcomes. These can include a direction to repay Medicare benefits to the Commonwealth or disqualification from providing MBS or PBS services. I strongly encourage you to contact your Medical Defence Organisation (or equivalent) which will be able to provide you with advice and assistance.
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 you 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. The information in this section can also be found in the following publication:
Professor Julie Quinlivan
Director, Professional Services Review