Medicare Compliance Part 1 - the role of the Professional Services Review (PSR)

In this episode, host Dr Maria Li is joined by Associate Professor Antonio Di Dio, a practicing GP and Director of the Professional Services Review (PSR), to discuss Medicare compliance, a topic of growing relevance and concern for Australian general practitioners.

Associate Professor Antonio Di Dio explains the role and remit of the PSR in Australia, outlining how it operates independently from Medicare and exists to protect both patients and the Commonwealth from inappropriate or unnecessary healthcare.

Key points:

• The origins and legislative framework of the PSR and its place within Australia’s compliance ecosystem.
• The mechanisms that trigger Medicare referrals to the PSR, including unusual billing patterns (data triggers) and external tip-offs.
• The structured review process, possible outcomes (including no action, agreement under Section 92, or referral to a committee), and criteria for progressing cases.
• Reassurances for GPs that a PSR referral does not automatically mean adverse findings, with many cases resulting in no further action.
• The role of peer input throughout the process, and emphasis on seeking mitigating circumstances.
• Consequences of adverse findings, including financial repayments and restricted billing, while clarifying that the PSR does not impact a doctor’s licence to practise (though it may refer cases to AHPRA under certain circumstances).
• Practical advice for GPs if subject to a PSR review: notify medical defence organisations early, seek support from trusted colleagues and family, and, if necessary, access doctors’ health services.

This episode is aimed at demystifying the PSR process, reducing unnecessary fear, and empowering GPs with knowledge on best practices for engagement and self-protection if under review.

Links & Resources:

• https://www.psr.gov.au/
• Medicare compliance | Australian Government Department of Health, Disability and Ageing
• https://www.health.gov.au/topics/medicare/compliance/how-to-comply?language=en

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