Part 7 – Referrals to Medicare Participation Review Committee Part 7 relates to the interaction between the PSR Scheme which is set out in Part VAA of the HIA and MPRCs which are established under Part VB of the HIA. MPRCs are statutory committees established on a case by case basis to make determinations on a range of matters relating to practitioners such as in relation to: • practitioners who have commissioned relevant offences or relevant civil contraventions ; or • approved pathology practitioners or authorities who are reasonably believed to have breached pathology undertakings; or • practitioners or persons who are reasonably believed to have engaged in prohibited diagnostic imaging practices; or • practitioners who have been found to have engaged in inappropriate practice on two separate occasions under the Professional Services Review Scheme. Currently, under subsection 106X(2), where a practitioner has been found to have engaged in inappropriate practice by a PSR Committee resulting in final determinations of a Determining Authority taking effect on two occasions, the Director must give to the Chairperson of a MPRC a written notice setting out the details of all final determinations that have taken effect against the person. An agreement between a practitioner and the Director under section 92 is taken to be a final determination of the Determining Authority for the purposes of section 106X (see paragraph 92(4)(f)). Under subsection 124E(2A), a MPRC must be established where the Chairperson receives a notice under section 106X. The MPRC then determines whether any further action should be taken against the practitioner to that determined by the Determining Authority. Under section 124FAA, the MPRC may determine that no further action be taken against the practitioner in addition to that action being taken under the final determination made by the Determining Authority under section 106TA. Alternatively, the MPRC may determine that the practitioner is disqualified (partly or fully) from providing professional services for a specified period not exceeding 5 years. A determination by the MPRC that a practitioner is disqualified replaces any period of disqualification under a final determination made under section 106TA that is still in force when the MPRC's determination is made. This Part removes the obligation imposed upon the Director under section 106X to refer practitioners who have been found to have engaged in inappropriate practice on two separate occasions (through either final determinations under section 106TA or negotiated agreements under section 92) to a MPRC. Instead, the Director (for agreements made under section 92) and the Determining Authority (for final determinations made under section 106TA) will be able to impose sanctions which are equivalent to those which are currently available to a MPRC under section 124FAA. This gives effect to Recommendation 9 of the Review of the Professional Services Review Scheme – Report of the Steering Committee – May 2007 which recommended the Determining Authority be given the power to enforce sanctions equivalent to those available to an MPRC.
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