Review of section 92 of the Health Insurance Act 1973: Professional Services Review

25 Nov 2021

Members will be aware that the Professional Services Review (PSR) scheme was introduced in 1994 by the Australian Government to safeguard the public against the risks and of costs of inappropriate practices of practitioners as well as protecting the integrity of the Medical Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS).

At the request of the AMA, the Department of Health has commenced an independent review of the procedural fairness of the section 92 process. Emeritus Professor Robin Creyke AO has been engaged to conduct the review. The AMA is making a submission to this review and is keen to hear from members about their views on the s92 process. 

Under section 92 of the Act, an agreement between a person under review (PUR) and the Professional Services Review (PSR) agency, would: (a) require the PUR to acknowledge that they have engaged in inappropriate practice in connection with rendering or initiating specified services during the review period; and (b) include a ‘specified action’. Commonly, a ‘specified action’ can include repayment of money relating to specific services, a period of partial or full disqualification from the MBS or PBS, and a reprimand from the PSR Director. 

The review will undertake an assessment of how section 92 of the Act is operationalised by the PSR to ensure PURs are treated fairly and have access to clear, transparent and comprehensive information about how the PSR Director’s review process and section 92 agreement negotiation phase operates. This includes considering:

  • the end to end process flow from the perspective of the PUR 
  • the extent of transparency of the process to the PUR, noting that the integrity of the PSR must be maintained
  • quality of information available to PURs about the section 92 process, and
  • feedback from key stakeholder organisations, such as peak health provider groups and medical defence organisations.

If required, the Review may make recommendations to improve the experience for PURs.

If you have feedback about the section 92 agreement process related to the above dot points on the scope of the review, please email AMA secretariat at consultations@ama.com.au by cob 2 December 2021.
Further information on the PSR and the Review: 

https://www.psr.gov.au/
https://www.psr.gov.au/sites/default/files/Your_Guide_to_the_PSR_Process_%282018%29.PDF