PSR orders doctors to repay more than $27m

Medical practitioners were ordered to pay back $27.3 million to the Federal Government in the last financial year following investigations by the Professional Services Review (PSR).
 
However, according to its latest annual report, the total sum of repayments is less than the $31.6 million ordered in the previous 12 months.
 
The bulk of repayments consisted of $19.9 million ordered across 90 negotiated section 92 agreements, which require a voluntary acknowledgement of inappropriate practice.
 
Of the negotiated agreements, 45 cases involved partial MBS disqualification, with one full disqualification, while 29 cases included reprimands and 76 cases featured a recommendation of counselling.
 
The PSR completed 115 reviews in 2024–25, with no further action taken in just seven cases.
 
It recorded 116 review requests from the Medicare chief executive in the same timeframe, against a five-year average of 101.
 
The PSR describes the pattern as a ‘return to the steady level of requests that was seen prior to the COVID-19 pandemic’.
 
‘In most cases, the Director or Associate Directors held concerns that practitioners had engaged in inappropriate practice because they had not kept adequate and contemporaneous records, did not provide sufficient clinical input into the services provided, the reviewed services were not clinically indicated or because the services did not meet the MBS or PBS requirements,’ the report states.
 
The PSR made 13 referrals to the Australian Health Practitioner Regulation Agency (AHPRA) in 2024–25 due to ‘non-compliance with professional standards’ – five fewer than the recent average.
 
Dr Tony Bayliss, the RACGP’s Medicare Compliance Lead and member of the RACGP Expert Committee – Funding and Health System Reform, notes that the number of GPs involved in PSR compliance reviews represents a fraction of the GP workforce.
 
‘There are 50,000 GPs, and this represents a very small number of compliance activities,’ he told newsGP.
 
‘The fact that the amounts being repaid are going down is reassuring as well as the number of cases.
 
‘Compliance is an ongoing task though, and it’s important for GPs to continue to look at their billing and work out what their risk profile is associated with that and adjust their billing practices accordingly.’
 
For the previous five financial years, the average number of referrals from the MBS compliance watchdog stood at 18, a figure that would be significantly higher were it not for a total of seven in 2022–23. There were 19 referrals in 2023–24.
 
‘Often these referrals were due to the practitioner’s management of patients, including their prescribing of opiates and their provision of skin excision services,’ the PSR report states of this year’s total.
 
It said reviews were requested for specialties including GPs, ophthalmologists, radiologists, cardiologists, obstetrician-gynaecologists, psychiatrists, a nephrologist, a general physician, a respiratory and sleep medicine specialist, an orthopaedic surgeon, a rehabilitation medicine specialist as well as a psychologist.
 
Eighteen final determinations by the Determining Authority – a statutory body formed to ratify and make decisions – also came into effect in 2024–25, accounting for a total of $7.4 million repayment orders, with sums ranging from $10,000 to $1.9 million.
 
There were also three fraud referrals over the financial year.
 
The PSR notes missing one target, with only 68% of cases finalised by the Determining Authority within nine months of receiving a report, against a target of 80%.
 
However other goals were met, including 76% of active cases being less than a year old against a target of 50%, and 9% of active cases dating back more than three years as of 30 June 2025, beating a goal of ‘fewer than 15%’.
 
‘Cases in this cohort were identified as being delayed for reasons including federal court action, PURs [Persons under review] having left Australia and not returned and PURs having serious illness affecting their ability to participate in the investigation,’ the report noted.
 
According to the PSR, commonly reviewed services include both in-person and telephone attendances, chronic disease management, health assessments and mental health services as well as services involving the prescribing of opioid medications and antibiotics.
 
There were 39 requests to review practitioners with an apparent ‘prescribed pattern of services’, including 29 referrals for 30/20 breaches involving 30 or more relevant telephone services on 20 or more days during the review period.
 
‘There continued to be an increase in the number of telehealth and telephone services items reviewed, reflecting an uptake in the use of these items by the profession,’ the PSR report authors wrote.
 
‘The common areas for concern in these services mirrored those for in-person attendances, being a lack of recorded information to reflect the clinical input provided.
 
‘The same record keeping requirements apply to telehealth and telephone services as for in-person attendances.’
 
Dr Bayliss said that while telehealth is ‘a great addition’ to the services that GPs offer, it is another area requiring vigilance.
 
‘This year GPs have been given warning, they’ve been given notification when they’ve been approaching some of the thresholds, so anyone who gets a notification, I would encourage to take that seriously,’ he said.
 
‘What the RACGP is doing with the PSR is organising programmes to help GPs and registrars to understand safe and appropriate billing, and we’re also looking at how we can assist GPs on the expedited pathway to ensure they adjust to the billing environment in Australia.’
 
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