The following sets out PSR’s performance criteria and provides details of its results for activities undertaken during 2018–19. This included work on the 125 cases already on hand at the commencement of the reporting period, and the 101 cases that were received during 2018–19.

A total of 101 cases were brought to a conclusion and, at the end of the reporting period, 125 cases had not been finalised and were in various stages of completion.

New referrals from the Chief Executive Medicare

The Chief Executive Medicare sent 101 requests in 2018–19. This figure is almost double the long term historical annual average for the agency.

In 2018–19, PSR completed 101 cases. Of these, two were the subject of a decision by the PSR Director to take no further action, 90 were resolved by negotiated agreements that were subsequently ratified by the Determining Authority (thereby becoming effective), and eight resulted in final determinations by the Determining Authority that became effective during the reporting period. One case was closed as a proper Final Determination was not possible.

No cases resulted in a finding by a PSR Committee of no inappropriate practice. During the reporting period, 19 cases were referred by the PSR Director to a Committee of peers. This too marks a significant increase on the historic annual average number of cases referred to Committee.

Table 2 compares PSR’s case statistics for 2018–19 with those of the previous reporting period.

Table 2: PSR’s case statistics, 2018–19 and 2017–18

AHPRA = Australian Health Practitioner Regulation Agency; PSR = Professional Services Review

a 15 referrals were in respect of 11 practitioners.

b As PSR receives referrals from Chief Executive Medicare throughout the year, case data cannot be reconciled within a 12-month period.

Cases in which no further action was taken

The Director can, after considering all the relevant material, decide to take no further action under s. 91 of the Act.

The Director took no further action in two of the 101 cases completed in 2018–19.

Negotiated agreements

Under s. 92 of the Act, the Director and the practitioner under review can enter into a negotiated agreement which must include acknowledgement by the practitioner that they have engaged in inappropriate practice, and include specified action such as a reprimand, repayment of some or all of the Medicare benefit received, and total or partial disqualification from participating in the MBS or PBS.

In 2018–19, 90 negotiated agreements became effective. Outcomes of these negotiated agreements included:

• repayment orders totalling $26,411,681
• partial disqualification in 62 cases and full disqualification in one case.

The practitioners concerned included general practitioners, other medical practitioners, midwives and specialists. Repayments ordered ranged from $10,000 to $995,286, with more than two-thirds of the agreements involving repayments of $200,000 and above.

PSR Panel and peer review Committees

Under s. 93(1) of the Act, the Director may establish a PSR Committee and refer a person under review to the Committee for investigation. The Committee then determines whether the person has engaged in inappropriate practice in providing the services specified in the Director’s referral.

Members of peer review Committees are drawn from practitioners who are members of the PSR Panel (Appendix 4).

The PSR Panel comprises health professionals from a range of professions, specialities, backgrounds and practice locations: 9% practise in inner regional areas, and 5% practise in outer regional areas. Women comprise 43% of the PSR Panel.

During 2018–19, the Director established 19 PSR Committees. Of the 19 practitioners referred to a PSR Committee, eight were general practitioners, two were specialists, six were other medical practitioners and the remaining three were a midwife, chiropractor and a dentist.

At the end of the reporting period, all of the PSR Committees established in 2018–19 were still in progress. Committee hearings were held for 20 cases during the 2018-19 financial year. Twelve Committee final reports had been completed and sent to the Determining Authority, and all contained findings of inappropriate practice.

The Determining Authority

During 2018–19, eight final determinations became effective. The directions made by the Determining Authority were:

• reprimand in all cases and counselling in seven cases
• partial disqualification from Medicare benefits in five cases, for between 6 and 36 months
• repayment of Medicare benefits, ranging from $1,297.20 to $649,664.90 (totalling $2,784,521.71).

Re-referrals

In 2018–19 the Chief Executive Medicare made three requests to PSR to review practitioners who had previously been referred to, and reviewed by the Director of PSR, and had an effective negotiated agreement or determination. At 30 June 2019, two of these cases were still under review and one had resulted in a negotiated agreement.

Referrals to medical boards and other authorities

The Act requires the PSR Director to refer practitioners to appropriate bodies when a significant threat to the life or health of any other person is identified, or if the person under review has failed to comply with professional standards.

In 2018–19, the Director made 15 referrals of practitioners to AHPRA, medical boards or other bodies. This is consistent with the levels of referrals in the previous financial year.

Judicial review

Practitioners involved in the PSR process can seek judicial review in the federal courts. Further detail relating to matters under judicial review can be found in the 'Legal issues' section of the Performance Statement.

One matter that had commenced in a previous year was determined in favour of PSR. Another matter that had commenced in 2017-18 was resolved by consent. A further matter that had commenced in the previous year had an interlocutory hearing and interlocutory judgment but had not had a substantive hearing during 2018-19. One further matter was commenced in the Federal Court in 2018–19 but was not heard during the year.