This page provides general information about what a review of a company (or other employing entity) will involve.
The Director’s review of your company begins when a delegate of the Chief Executive Medicare requests the Director to review your company’s role in relation to services provided by practitioners who were employed or otherwise engaged by your company during a specified period.
The Director considers the request from the Chief Executive Medicare and any other relevant material. If it appears to the Director that your company may have engaged in inappropriate practice, the Director must conduct a review.
Every corporate referral will be managed differently, with the process tailored to reflect your company’s specific circumstances. However, the review will always follow the legal process outlined in Part VAA of the Health Insurance Act 1973. There will be multiple opportunities for your company to present its case and make submissions to the Director, a PSR Committee and the Determining Authority.
The Referrals to PSR section of our website explains the review process that PSR follows for individual practitioners who are referred to the PSR Director
- Stage 1: PSR Director reviews the information
- Stage 2: PSR Committee decides if inappropriate practice occurred
- Stage 3: Determining Authority makes its decision.
The Director’s review of a corporate entity focuses on:
- the practitioners’ provision of MBS or CDBS services and/or prescribing of PBS medicines
- your company’s role, if any, in causing or permitting the practitioners’ conduct.
There are two elements that must be present for a finding of inappropriate practice. The Director assesses whether:
- your company’s practitioners might have engaged in inappropriate practice during the specified period
- your company might have knowingly, recklessly or negligently caused or permitted them to do so.
If the Director decides that your company may have engaged in inappropriate practice, the Director has two options. They may either:
- dismiss your company’s matter
- refer your company to a PSR Committee.
The Director does not have the power to enter into a negotiated agreement with a corporate entity.