Glossary

the Act

the Health Insurance Act 1973

AMA

Australian Medical Association

Committee

a PSR Committee comprising at least 3 practitioners which is set up to investigate inappropriate practice in line with section 93 of the Act

CDBS

Child Dental Benefits Schedule

Committee member

a member of a PSR Committee, who must be a current Panel member

Deputy Director

a Deputy Director of PSR appointed under section 85 of the Act, who can serve as the chair of a Committee

Determining Authority

the independent statutory body established under the section 106Q of the Act that can ratify agreements and make determinations

Director

the Director of PSR appointed under section 83 of the Act

Director's review

the Director’s review process as set out in Division 3A of Part VAA of the Act

Draft determination

the draft document containing the Determining Authority’s proposed action as required by section 106T of the Act.

Draft report

the preliminary findings of a Committee following a hearing as required by section 106KD of the Act

Final determination

the final document containing the action that will be taken in a case as required by section 106TA of the Act

Final report

a Committee’s final findings following assessment of further submissions by a practitioner in response to a draft report as required by section 106L of the Act

Inappropriate practice

Defined under section 82 of the Act as conduct that a Committee of the practitioner's peers could reasonably conclude was unacceptable to the general body of their profession. See the inappropriate practice section for more details.

MBS

Medicare Benefits Schedule

Medicare

the Medicare program

Medicare Services

services provided by a practitioner that generated a Medicare benefit

Minister

the Minister for Health

Negotiated agreement

written agreement made under section 92 of the Act

Over-servicing

providing a patient with services in excess of their actual medical need

Panel

the PSR panel established under subsection 84(1) of the Act, whose members are available for appointment to a Committee

Panel member

a practitioner appointed to the Panel under subsection 84(2) of the Act

PBS

Pharmaceutical Benefits Scheme

Peers

the members of the PSR Panel who are appointed to represent the general body of their profession

Person Under Review (PUR)

practitioner or another person or corporate entity who has been referred to the Director for review

Practitioner

Aboriginal and Torres Strait Islander health practitioner, Aboriginal health worker, audiologist, chiropractor, dental practitioner, diabetes educator, dietician, exercise physiologist, medical practitioner, mental health nurse, midwife, nurse practitioner, occupational therapist, optometrist, orthoptist, osteopath, physiotherapist, podiatrist, psychologist, social worker or speech pathologist

Prescribed pattern of services

Defined as providing 80 or more relevant services or 30 or more relevant phone services on 20 or more days over 12 months. This pattern results in automatic referral to PSR. If exceptional circumstances are established, the volume of inappropriate practice is reduced by those days on which exceptional circumstances are found to have existed and affected a person’s provision of services.

PSR

Professional Services Review

Ratify

to authorise or approve (a negotiated agreement)

Review period

a period of no more than 2 years before the request for review from the Delegate of the Chief Executive Medicare

Sanction

One of a range of directions specified in section 106U of the Act. These include reprimands, repayments and disqualifications.

Services Australia

Formerly the Department of Human Services, this agency administers payments relating to Medicare, PBS and CDBS.