PSR boss: ‘We never make assumptions’

This financial year is shaping up to be one of the busiest ever for the Professional Services Review (PSR).
 
So far in 2023–24, the body has already received 85 referrals from Medicare, resulting in the partial disqualification of 46 practitioners.
 
The agency’s role is to investigate Medicare-referred cases of possible inappropriate practice, and while the review insists it has not ‘gone soft’, its leaders say it is changing to better listen to and understand the GPs it is investigating.
 
Almost two years into his role in the top job, Acting Director and GP of 30 years, Dr Antonio Di Dio is working to reassure GPs that they are being heard and their wellbeing is his priority.
 
‘It’s no good being a regulator and having the practitioner coming out of the process being crushed, and devastated, and never wanting to work again – that is not a good outcome for anybody,’ he told newsGP.
 
‘We may agree or disagree with the arguments that practitioners under review present, but I want to make it very clear to them on every single occasion that their arguments are listened to.
 
‘Every single practitioner who comes to PSR, we offer them a one-on-one interview that goes for at least an hour, not with a case officer or a case manager, but with me.
 
‘We never make assumptions – sometimes the referrals have some extraordinary statistics, [but] under no circumstances are assumptions ever made.’
 
Last year, the PSR received 91 requests from Medicare, of which 19 generated no further action – a stark contrast to five years ago when it received 109 requests with just one resulting in the same outcome.
 
The high rate of Section 92 agreements finalised between the PSR and practitioners – 98% in 2018–19 – generated considerable angst among the medical profession, with a Federal Court judge even labelling the body a ‘star chamber’ in 2021.
 
Likewise, a 2023 report into the service’s use of Section 92 agreements raised concerns around a lack of transparency, recommending that more information be published about the duration of the process and compliance outcomes.
 
An RACGP submission into the issue also raised similar concerns, especially that GPs did not feel empowered when entering into the decision, despite choosing to do so.
 
‘They are being asked to make a voluntary acknowledgment of inappropriate activity, without always understanding how they are at fault,’ it said.
 
But while six section 92 agreements have already been reached in the first month is this year alone, with four of those being GPs, RACGP President Dr Nicole Higgins said the college has now developed a strong working relationship with the body, following what she says was a change from a punitive approach, to an educational one.
 
‘This is a peer-reviewed approach, an integrative approach to cause the least amount of harm to doctors when they’re in crisis,’ she told newsGP.
 
‘There’s increasing transparency and understanding around the role of the PSR, but what Dr Di Dio and his team have done is try to make this as simple as possible, and for something that is a really difficult process for anybody, they’re trying to make the best out of a bad situation.
 
‘Listen to the education, to the advice that’s given about how not to end up there in the first place. But if you are, know that there are GPs there to make sure that the process is fair and transparent.’
 
Dr Di Dio acknowledges receiving a PSR letter can be a scary experience, but he wants GPs to know their case will be respected, listened to, and ‘forensically attended to’.
 
‘It is deeply distressing … all health practitioners who receive these notifications receive a variety of emotions ranging from anger, shame, embarrassment,’ he said.
 
‘The majority of practitioners under review have never been through this process before and the best way for us to ensure that their best interests are looked after is to make sure that they get legal representation.
 
‘Often there’s a case where you see a practitioner, who is kind, and caring, and clinically good, and has just, because of a lack of awareness or understanding, accidentally billed the wrong number.
 
‘Sure, that person has engaged in inappropriate practice, but they haven’t done the wrong thing, or prescribed the wrong medicine, or attempted fraud or anything like that.’
 
When a medical professional is referred to the PSR, there are three stages of the review process.
 
First is Dr Di Dio reviewing the information to decide what action, if any, should be taken, then a committee of practitioners relevant to the person being investigated will decide if inappropriate practice occurred.
 
Finally, a determining officer will make a decision and decide what sanctions should be imposed.
 
Dr Di Dio said there are several reasons why the number of cases requiring no further action has increased in recent years, citing individual anomalies to COVID-19.
 
‘What would be disastrous for us is somehow confusing that view of the safety and care of practitioners, with a policy about going soft – there’s no such policy,’ he said.
 
‘The biggest driver was the 80/20 matters, because the compliance team are obliged to refer the 80/20 matters to PSR, whereas with all the other matters they can make up their own mind … so many of them were 80/20 breaches who had practised what was clearly very fine medicine.
 
‘It was in the acute stages of the pandemic for those reviews and many of those matters had no further action outcome because the breach was caused by quite literally exceptional circumstances.’
 
The PSR has put together a range of explanatory tools for practitioners to better understand and prepare for a review. 
 
Moving forward, Dr Di Dio hopes GPs will trust the PSR, saying he wants the process to focus on the human at the centre of it, rather than the investigation.
 
‘It is vital that there be a compliance system for the sustainability of Medicare,’ he said.
 
‘I want GPs to be happy, and feel safe, and secure – in my perfect world, that’s what I want them to think because one of the most precious things to GPs is Medicare, and it’s also one of the most precious things to 27 million Australians.
 
‘It’s there to protect 100% of Australians and it’s there to protect the interests of 99% of all practitioners.’
 
Dr Higgins backed these calls, and said it is important that the GP profession has ownership around its regulatory bodies.
 
‘They bring an understanding of the context, and the environment, and the situation that doctors often find themselves in,’ she said.
 
‘It’s not black and white, it’s very nuanced, and that is why we need to make sure that we’ve got doctors there supporting doctors, because if the profession doesn’t, it will be imposed upon us.’
 
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