What are the possible outcomes?

There are six outcomes from the PSR process which can be determined at various stages of a matter.

The six outcomes are:

  1. No further action – a finding that you have not practiced inappropriately. Your matter is closed
  2. Reprimand – a written reprimand given to you by the Director
  3. Counselling – an exchange of information given to you by the Director about why you were found to have practiced inappropriately and what action you should take to avoid it occurring again
  4. Repayment order – an order for you to repay Medicare benefits that you received or caused to be paid
  5. Partial/full disqualification from Medicare – a disqualification of up to 3 years (or 5 years in some circumstances) from some or all MBS items. This means the services you provide to your patients will not attract a Medicare benefit
  6. Disqualification from the PBS – a disqualification of up to 3 years from prescribing or dispensing PBS items to your patients.

A decision that no further action be taken can be reached at three stages of the process. These are when:

  • the Director decides not to undertake a review of your practice
  • the Director undertakes a review and decides that there is no evidence to indicate a Committee could find that you had engaged in inappropriate practice
  • a Committee undertakes a review of your practice and finds that you did not practice inappropriately during the review period.

One or more of the sanctions may be imposed at two stages of the process. These are when:

  • the Determining Authority ratifies an Agreement you have entered into with the Director under section 92 of the Act, which contains one or more sanctions
  • the Determining Authority considers a Committee Final Report and makes a Final Determination containing the decision on the appropriate sanctions to apply.

Publishing Committee outcomes

If your matter is referred to a Committee and a finding of inappropriate practice is made the Director can publish your name, address, profession/speciality, the nature of your conduct and the sanctions the Determining Authority applied. The option to publish information becomes available to the Director only after a Final Determination has come into effect.

Patient safety, unprofessional conduct, or fraud

At any time during the PSR process, a referral to a regulatory body could be made.

If clinical information revealed during the review causes the Director, a Committee or the Determining Authority to have a concern regarding any significant threat to a patient's life or health, or non-compliance with professional standards, the matter may be referred to the relevant professional disciplinary, regulatory, or registration body.

If the Director or Committee has reason to consider that there may have been fraud or another offence under the Health Insurance Act has been committed, the matter may be referred to the Department of Health for investigation.