Review by the Director

Detailed information on the PSR scheme is published in the document Your Guide to the PSR Process

As set out in the Health Insurance Act 1973 (the Act), Medicare Australia may request the Director of PSR (the Director) to review the provision of services by a person during a specified period. The period specified must be within 2 years immediately preceding the request. The request must include reasons. Medicare Australia must give the person written notice of the request within 7 days.

The Director may request further information from Medicare Australia to assist in making a decision whether to conduct a review, or for conducting the review. The Director has 1 month from receipt of the Medicare Australia request to decide whether or not to undertake a review.

The Director must undertake a review if, after considering the Medicare Australia request and any other relevant material, it appears to the Director that there is a possibility that the person has engaged in inappropriate practice in providing services during the review period. The Director must notify the person and Medicare Australia of the decision to undertake a review.

The person must also be provided with information about the Director's power to request medical records and other relevant documents under section 89B of the Act at this time.

If the Director decides not to undertake a review, the person and Medicare Australia will be notified accordingly. The notice given to Medicare Australia must also include the grounds for the Director's decision.

Where documents are required to be produced, the Person under Review (PUR) will be notified of the consequences of failing to produce them. These are that services rendered or initiated by the PUR will not attract a Medicare benefit until the practitioner complies with the notice (s 106ZPM). Refusal or failure to comply with a notice by a person other than the person under review is an offence under section 106ZPN of the Act.

The Director may review any or all of the services provided by the PUR during the review period, may undertake the review in whatever manner is thought appropriate and is not limited by the reasons in the Medicare Australia request.