The PSR review process

The PSR review process

If you are referred to PSR, you will receive a request to review document from the delegate of the Chief Executive Medicare referring you to PSR.

The PSR Director considers the request and any other relevant material. If it appears to the Director that there is a possibility that you engaged in inappropriate practice, they will do a review. At this point, you will receive a letter from PSR informing you that your provision of services is under review.

In its review, PSR considers whether you have engaged in ‘inappropriate practice’ during a defined period. The PSR review will result in one of 3 outcomes:

1. no further action
2. the negotiation of an agreement, which requires you to acknowledge that you engaged in inappropriate practice when providing MBS, PBS or CDBS services and involves specified actions
3. referral to a Committee of your peers for further investigation.

If the outcome of the review is an agreement or referral, this can have significant consequences for you. You may have to repay Medicare benefits and you may be partially or fully disqualified from providing MBS, PBS or CDBS services for a specified period.

The review process can be time consuming, legally complex and stressful. To prepare for it, read this section of the website carefully. You can also download this guide that explains the process.

If you have any questions about your review, contact the PSR staff listed in the letter from us. If you have any feedback about your review, email us using our Contact us form

Preparing yourself for the review

At the start of the review process, you should take 3 key steps:

1. Engage your medical defence organisation or a legal representative as early as possible to help you through the process. We strongly encourage you to do this as medical defence organisations are familiar with the administrative and legal requirements of the PSR process and can advise and guide you.
2. Inform people close to you about your PSR referral. While this is your choice, it can be helpful if you have someone to discuss the matter with.
3. Familiarise yourself with your request to review document. It details the reasons you have been referred to PSR, the concerns about your practice and the statistics of your practice during the review period.

Understanding the review process

PSR will review your case following the legislated process, which has up to 3 stages:

• Stage 1: PSR Director reviews the information
• Stage 2: PSR Committee decides if inappropriate practice occurred
• Stage 3: Determining Authority makes its decision. Each stage is presented in detail in the next 3 sections.

Please note that we are committed to protecting your privacy and your patients’ privacy in line with the Privacy Act 1988 and section 130 of the Health Insurance Act 1973. We operate within a secure environment that cannot be accessed by the public. All documents about your case will be stored securely on our protected IT systems.