Our functions and powers

What we do

Our purpose is to protect the integrity of the MBS, PBS and CDBS. In doing so, we protect:

patients and the community from the risks associated with inappropriate practice
the Commonwealth from having to meet the cost of medical/health services provided because of inappropriate practice.

We do this by reviewing services provided by a person to determine if they engaged in inappropriate practice. All reviews are initiated by the Chief Executive Medicare, who may ask the PSR Director to review the person's provision of services during a specified period.

PSR’s functions include:

reviewing a person under review's services during a specified period. This may include issuing notices to produce documents and engaging consultants
negotiating agreements with persons under review. The terms may include a period of partial or full disqualification from the MBS or CDBS, a full disqualification from the PBS, or repaying benefits for specific services
establishing Committees, which can review and investigate practitioners, and may find inappropriate practice has occurred. This may lead to a period of partial or full disqualification from the MBS, or CDBS, a full disqualification from the PBS or repaying benefits for specific services
referring practitioners to Ahpra
referring material to the Chief Executive Medicare if we suspect certain offences or fraudulent behaviour has occurred

Why we can do it

PSR was set up to administer the PSR Scheme as set out in Part VAA of the Health Insurance Act 1973. We are an independent statutory agency in the Health and Aged Care portfolio. Our head is the PSR Director, who has a range of powers and responsibilities under the Act.

Our functions

PSR’s 5 main functions are described below.

1. The PSR Director reviews services

For all reviews, the Director must decide to either:

take no further action
negotiate an agreement with the practitioner
refer the practitioner to a Committee.

During a review, the Director has the power to:

compel the person under review or relevant third parties to produce relevant documents
consult any PSR Panel member, learned professional body or other consultant (that the Director considers appropriate) to help in making their decision
enter into an agreement with the person under review
establish a Committees and refer a person under review to a Committees.

For more information, please refer to Stage 1.

2. The PSR Director negotiates agreements

The Director may negotiate a written agreement with a person under review in which the practitioner acknowledges that they engaged in inappropriate practice and agrees to one or more of the following:

a reprimand from the Director or the Director’s nominee
Counselling from the Director or the Director’s nominee
repaying benefits for specific services
a period of partial or full disqualification from the MBS or CDBS, or a full disqualification from the PBS.

For more information, please refer to Stage 1.

3. Our Committees conduct investigations

If the Director considers that a practitioner might have engaged in inappropriate practice, they may set up a Committee and ask it to investigate whether the practitioner engaged in inappropriate practice.

The Committee conducts its own investigation and has the power to:

conduct hearings and require the person under review to attend them
summon a person to give evidence at a hearing
compel the person under review or a relevant third party to producee relevant documents
make findings about the person under review’s practice.

For more information, please refer to Stage 2.

4. The Determining Authority can refuse or ratify agreements

The Determining Authority has two functions.

The Determining Authority decides whether to ratify agreements made between the Director and a person under review.

The Determining Authority considers a Committee’s final report, and may make any of the following directions:

the Director or the Director’s nominee is to reprimand the practitioner
the Director or the Director’s nominee is to counsel the practitioner
the person under review is to repay benefits for services
the practitioner is to be disqualified from providing certain services for a specified period
the practitioner is to be partially or fully disqualified from billing MBS or CDBS items, or fully disqualified from the PBS for a specified period.

For more information, please refer to Stage 3.

5. We can refer practitioners to regulatory bodies

The Director, a Committee or the Determining Authority can refer practitioners to a relevant regulatory body if they are concerned that the practitioner has:

caused significant threat to somebody’s life or health
not complied with professional standards.

If the Director or Committee is concerned that a person under review may have committed an offence or acted fraudulently (in line with section 124B of the Act), they may refer the matter to the Chief Executive Medicare for further consideration or investigation.