Stage 2: PSR committee decides if inappropriate practice occurred

Setting up the Committee

The Committee of peers is an independent decision-making body established by the Director, with at least 3 members drawn from a panel of practitioners appointed by the Minister for Health and Aged Care:

a Chair, who is both a Deputy Director and member of the panel, and must be a member of your profession
at least 2 members of your profession or specialty (in most cases)
an extra 1–2 members if the Committee needs a wider range of clinical expertise.

To set up the Committee, PSR follows these steps:

Who	What
Director	sends you documents that detail: the membership of the Committee the MBS, PBS and/or CDBS items that they have referred to the Committee a report explaining why the Director thinks you may have engaged in inappropriate practice
You	should engage a legal adviser if you have not already done so may challenge the appointment of a Committee member on the grounds of bias by writing to the Director within 7 days of receiving their letter, detailing the basis for your challenge
Director	decides if your challenge is justified and if so, appoints a replacement member to the Committee

Examining the evidence

Once the committee is established and it decides to conduct an investigation, it usually follows this process:

Who	What
Committee	decides which of the referred MBS, PBS and/or CDBS items it will examine obtains patient details for a sample of services you provided for each item sends you a notice asking you to provide the records, including how to submit the records electronically (which we strongly prefer) or by courier
You	provide electronic records or send by courier contact the PSR staff member listed on the cover letter if you have any questions about this notice
Committee	considers the evidence and decides on one of the following options: to close the case if it finds you have not practiced inappropriately to hold a hearing if it considers that it is possible that you engaged in inappropriate practice

Hearing the case

If the Committee decides to hold a hearing, its aim will be to:

collect information to help it decide whether your conduct when providing services would be unacceptable to the general body of your peers
allow you to respond to the matters the Committee is considering.

The Committee will consider a range of matters including:

your clinical decisions and input
if the services you provided were necessary for the appropriate treatment of the patient
if the services were justified and appropriate in light of the MBS item descriptor and/or PBS restrictions
whether your medical records were adequate and contemporaneous.

Committee hearings are usually held:

in 2-day blocks and last for 4 to 6 days, but can be longer
from 9:30 am – 5 pm, with breaks throughout the day so the Committee can confer and you can have a break
in a tribunal room in your closest capital city.

Hearings are closed, which means that only certain people can attend:

the Committee
PSR staff to advise and help the Committee
a person to record the hearing so it can be transcribed later
you and your legal adviser.

Before the hearing, the Committee will follow these steps:

Who	What
Committee	sends you (or your legal adviser) a notice of hearing (at least 14 days before the hearing), including: the hearing dates the hearing venue the need for you to attend and give evidence at the hearing the serious potential consequences if you fail to attend a PDF document containing your records, progress notes and documents about the services under review, bookmarked for ease of use.
You	contact PSR staff as soon as possible if you cannot attend on any of the dates are responsible for your costs of attending the hearing, including any travel and accommodation

At the hearing, the Committee process is:

Who	What
Chair	makes an opening statement informing you of the hearing structure accepts into evidence the relevant documents
You	may tender relevant documents
Committee	requires you to answer questions under oath or affirmation asks you general questions about: your practice and experience billing practices record keeping other matters asks you questions about specific services you have provided may take turns questioning you
You	may (subject to reasonable limitations the Committee imposes): be accompanied by a lawyer or another adviser call witnesses to give evidence (but not about your character) produce written character references question a person giving evidence at the hearing address the Committee on questions of law that arise make a final address to the Committee covering questions of law, the conduct of the hearing and the matters that were discussed at the hearing ask the Chair for a break at any stage
Your adviser	may (subject to reasonable limitations the Committee imposes): advise you address the Committee on questions of law that may arise (if they are a legal adviser) make a final address to the Committee covering questions of law (if they are a legal adviser), the conduct of the hearing and the merits of the matters discussed during the hearing

Preparing a draft report

After considering the evidence and any final address, the Committee prepares its findings and issues a report. If it finds you did not practise inappropriately, the matter will then be closed.

However, if the Committee decides to make a preliminary finding that you engaged in inappropriate practice, it will follow the steps below.

Note that even if the Committee examined only a random sample of at least 25 services you provided under a particular class of MBS item, it can extrapolate findings of inappropriate practice to all services of that class of MBS item you provided during the review period.

Who	What
Committee	prepares a draft report outlining: the Committee’s preliminary findings about each service that involved inappropriate practice the reasons for those findings invites you to respond to the report within one month
You	may prepare a submission addressing the Committee’s specific findings and suggesting changes to the report
Committee	considers your submission prepares its final report

Issuing a final report

If the Committee finds that you did not engage in inappropriate practice it will send its final report to you, the Director and Medicare. No further action will be taken.

However, if the Committee finds that you did engage in inappropriate practice, its final report will:

detail these findings
be sent to you and the Director
be sent to the Determining Authority after one month, so they can decide what outcome should follow from the Committee’s findings. See Stage 3.

Note that the Committee cannot make a finding of inappropriate practice in its final report unless it also did so in its draft report.