Retrospective PSR legislation introduced by Minister Plibersek

Laws to retrospectively validate past PSR findings, extend the scope of the review to all MBS-claiming practitioners and “automatically” deem any breach of the 80-20 rule inappropriate practice have been introduced to parliament this morning.

Health Minister Tanya Plibersek presented the Health Insurance Amendment (Professional Services Review) Bill to Parliament for a second reading this morning and the legislation is expected to clear the lower house today.

The legislation would prevent any further court challenges based on the invalid appointment of PSR committee members and safeguard more than $5 million in Medicare claims ordered to be repaid by doctors found to have practised inappropriately over the past 5 years.

The legislation follows the successful challenge of committee appointments by four NSW GPs on the grounds the government had failed to consult the AMA as required by law.

The government has been granted leave to appeal that decision in the High Court on the condition it pays costs for the GPs involved and has agreed not to attempt to overturn a previous order to pay their costs for the Federal Court proceedings.

However, the new legislation will allow the PSR to “establish and re-refer” those matters to new PSR committees regardless of the outcome of the appeal.

Ms Plibersek told Parliament the bill would also “enable the PSR Scheme to be applied to all health professionals who provide Medicare services” and provide an automatic trigger for GPs who see more than 80 unreferred patients on 20 or more days in any given year.

“This bill clarifies…that a practitioner who performs this number of services is automatically deemed by the legislation to have practised inappropriately, unless they can provide evidence that exceptional circumstances existed,” she said.

“Patients will also be protected by amendments that will require all persons who are disqualified from Medicare due to a [PSR] or Medicare Participation Review Committee process to display a notice to inform patients that services will not attract Medicare benefits.”

“Medicare and the [PBS] are two of the key pillars of Australia’s health system… this bill will ensure that the [PSR] continues to protect the integrity of Medicare and to support high quality, appropriate and safe health services for all Australians.”

More in Medical Observer's e-News later today.