What constitutes inappropriate practice? PSR boss speaks out

The head of the Professional Services Review (PSR) has spoken out about the ‘common traps’ the agency sees GPs falling into, the growing use of artificial intelligence (AI) in practice, the most reviewed items, and his priorities as director.
 
One year after he took over the top job, Associate Professor Antonio Di Dio has spoken directly to GPs at an RACGP webinar, alongside college President Dr Michael Wright.
 
The webinar discussed examples of referrals the PSR has received in the past year, what it expects to see over the next year, and the Medicare Benefit Schedule (MBS) item numbers that most commonly prompt referrals.
 
Associate Professor Di Dio said most GPs are ‘honest and fair in all of their dealings’, and with this in mind, he wants to ensure they can practice without ‘unnecessary fear and anxiety about regulatory bodies’.
 
‘We exist for two purposes, and that is to protect patients from the harm of inappropriate healthcare, and to protect the Commonwealth from paying for inappropriate practice,’ he said.
 
He revealed that in 2024–25, the PSR finalised 115 cases, up slightly from 109 the previous year, with no further action taken in seven cases, and 89 Section 92 agreements entered into.
 
Historically however, the rate of Section 92 agreements finalised between the PSR and practitioners has created considerable concern among the medical profession, with a Federal Court judge labelling the body a ‘star chamber’ in 2021.
 
An RACGP submission into the issue also raised similar concerns, highlighting that GPs do not feel empowered when entering into the decision, despite choosing to do so.
 
In response to these concerns, Associate Professor Di Dio said the PSR is working hard to ensure GPs do not ‘fear us unnecessarily and they don’t have one extra anxiety in medical practice, which, quite frankly, none of us need’.
 
‘We can’t tell you didactically how to avoid engaging in appropriate practice in connection with providing either MBS or PBS services,’ he said.
 
‘The test for inappropriate practice depends on what the general body of GPs would deem and requires consideration of the very specific individual circumstances of the practitioner and of that particular service.
 
‘Every one of us is incredibly different in how we do things, and every one of us has very different circumstances – city or country, big practice or small practice, easy patients, unbelievably challenging patients.
 
‘There is no guaranteed “get out of jail card” … everything is done according to “what would my peers think”.’
 
The most reviewed items over the past two years were revealed to be items 91891, 23, and 36, with around 78 referrals each, with items 723, 721, 732, 44, and 5020 also commonly reviewed.
 
Looking forward to 2025–26, Associate Professor Di Dio said the PSR is expecting an expansion of the 30/20 referrals with ‘business as usual in terms of mix of practitioners’, as well as a steady number of new requests to review.
 
Explaining the PSR’s process, Associate Professor Di Dio, who is also a GP of more than 30 years, said when a person gets referred to the agency, the director starts off by deciding whether to undertake a review or not.
 
‘Then, the practitioner under review is offered an interview, which generally goes for an hour, in order to clarify any preliminary worries or concerns we may have about that billing,’ he explained.
 
‘The director, then, or the associate director, takes some time and makes a decision as to whether or not inappropriate practice has occurred.
 
‘About 20% of people get referred to a PSR committee and that is basically a group of usually three people who are the person’s peers … this is the group that decides what, if any sanctions will be applied based on the findings of the committee.’
 
Associate Professor Di Dio added that ‘inappropriate practice’ does not mean malpractice or bad clinical medicine.
 
‘If you saw a patient and you did a magnificent consultation, and wrote down a fantastic history, [did] a fantastic examination and management plan, but yourself or your practice manager accidentally billed a 44, and you’d only seen the patient for a respiratory infection, and they were in your room for eight-and-a-half minutes – that’s inappropriate practice,’ he said.
 
‘It’s not bad clinical medicine, it’s just inappropriate practice, and it may be deliberate, or it may be completely accidental.
 
‘We decide whether, in your opinion, if this particular service, on this particular occasion, and this particular item that we’re looking at, and this particular medical record, and this particular patient’s notes, that the practice was okay or not okay.’
 
Speaking to AI and its growing usage in general practice, Associate Professor Di Dio said requirements for an adequate record do not change ‘no matter how it is created’, with that responsibility continuing to be with the practitioner.
 
Following the webinar, Dr Wright told newsGP it is helpful for GPs to understand that a PSR referral is a very uncommon event and is the ‘pointy end of compliance’.
 
‘I’m grateful for Associate Professor Di Dio for trying to provide a more understanding and caring approach,’ he said.
 
‘It’s great to see him recognising the anxiety that these compliance activities can cause and acknowledging the impacts that they can have on us as GPs.
 
‘Having a GP in his role is really helpful to bring the empathy and care that we show in general practice into this role.’
 
The PSR webinar was the second in a series of RACGP compliance webinars, with the first covering Medicare compliance with the Department of Health, Disability and Ageing also available for members to rewatch online.
 
Log in below to join the conversation.

compliance Medicare Professional Servies Review PSR