13 July 2021

Why you should stand up to the PSR

Comment KnowCents Medicare PSR

With the end of financial year just gone, we probably all spent lots of money and time figuring out the best tax saving strategies and ensuring we rely on the best and most affordable tax agent to optimise our financial status.

One would assume that these tax agents have had sufficient training, and certification process that enable them to handle these accounts making sure we are not breaking the law and that we are maintaining our compliance and obligations towards the Commonwealth.

Little do we know or realise that we are miniature tax agents for the Commonwealth without the proper training, certification, and or support.

Why?

What do you think Medicare money is?

We are billing and receiving public funds from Medicare (yes, reassigned insurance money from the patient), and yet, nowhere in our medical training do we actually get taught and signed off on the proper usage and standards to be followed for these item numbers. But somewhere down the road, as health practitioners billing Medicare, we are likely to have the pleasure of encountering the Medicare audit, and or the Professional Services Review scheme.

A surprising number of people in our profession do not actually know what the PSR is and what it entails. This is the first of a series of articles illustrating the intricate details and ramifications of what PSR stands for and what it means for us practitioners.

The general points to consider when wondering if this is applicable to you are the following:

  1. Do you receive Medicare rebates reassigned to you by your patients (whether privately billing or bulk-billing)?
  2. Do you use that money to pay for your groceries, gym membership, kids school fees, mortgage etc.?
  3. Do you practice in subspecialised and niche areas of medicine/healthcare?

If you have said YES to any one of those three questions, here is what can happen if you attract the attention of the PSR:

  1. You could lose a lot of money that you never really earned. If the PSR Director/committee/Determining Authority determine that you have ‘in their opinion’ billed inappropriately, you will be asked to pay back not only the money you actually tangibly received but the tax and the service fees you have paid your practice. It is then up to you to sue to get that service fee portion back and sort out your tax adjustments. In other words, you will be financially challenged no matter how savvy you are with your money.
  2. You will be made to feel like a fraud and a rorter. People who claim to have survived Medicare audits (which is completely different to PSR) will make you feel like a thief, even though nobody who answers yes to the above is exempt from this scheme.
  3. You will suffer mental and physical assaults while you go through this system because regardless of what you have experienced in life up to now, this is a textbook example of what existential crisis can look like. The more honest and hardworking you are, the more likely this process is to break you.

Therefore, YES, we need to know a great deal about this process and be aware of our rights, taking each other seriously with the right support.

Let’s talk about support. Whenever we are audited or sued, you would obviously want proper legal advice. Especially now, since many cases have risen against the PSR there are quite a few law firms and solicitors/barristers who can really help and minimise damage for those under review.

However, the irony of this scheme is that the legislation itself has limitations on how these lawyers can help. Lawyers can hold your hand through this process, but they are not allowed to “represent” you as such. They cannot speak on behalf of you during a committee hearing, they cannot cross examine the committee members and they cannot really advocate for you in any effective way. Is this fair? Well, this is one of the questions we are asking the courts to decide as we wait for judgements to come.

When should you involve the right legal team? Right at the very beginning. That first friendly phone call you get from Medicare, after saying “Thank you for the phone call, please put everything in writing, I will consider the material with my legal counsel and get back to you”, the next phone call should be to your MDO and then to your chosen legal team.

Each case is different. Not everyone needs to or has the ability to fight the system. Some may benefit by optimising their chances of getting a Section 92 agreement prior to going to the committee and some definitely should go to the committee, essentially getting ready for a Federal Court challenge. Either way, if you involve the right team from the beginning, just like a well prepared tax return, there is little chance of unnecessary errors and better chances of ensuring you have been able to exercise all your rights under the law.

One of the biggest obstacles we face is our own fear of being exposed or tainted as the rorter. Perhaps I am too thick-skinned to feel the heat, but honestly, people: unless you know you have done something that is unlawful, there is no need to be ashamed or shy about coming out and fighting for what is true and right. You may not come out completely exonerated – because let’s face it, nobody is perfect and perhaps you have indeed made some errors – but do not roll over and accept guilt because you just want to move on, or you are too ashamed to tell people.

Join the club. Stand up for your rights. Gain the knowledge, seek the right advice make sure you are not compromising yourself as a healthcare professional. There is a lot of help available out there, and I certainly feel the tide has turned, so reach out and watch this space for more information coming your way!

Dr Karmakar is the founder and CEO of AHPAS.

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5 Comments on "Why you should stand up to the PSR"

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Dru Haywood
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Dru Haywood
4 months 19 days ago

Thanks for this article
Two questions:
What is section 92?
And when do medicare audits go to the PSR? What is the difference?

Anchita Karmakar
Member
Anchita Karmakar
4 months 19 days ago
Hey Dru! Great questions! 1)Section 92 agreement is an agreement /negotiations between the Director of PSR and yourself where you agree on what is deemed inappropriate and agree to payback the agreed amount which basically stops the process from going forward. Its a Directors decision to make so good strong negotiations are very important along with strong submissions. 2)Medicare audits on and off all the time. They may do the nudge letters, they may want to have friendly chats, they are responsible for AskMBS etc. Many Doctors experience this and more then often people get off with little or no… Read more »
Pratap
Guest
Pratap
4 months 19 days ago

Excellent We need to stand up for our rights

JOHN QUAYLE
Guest
JOHN QUAYLE
4 months 19 days ago
I have been through this many years ago – I took on the PSR head and to settle agreed to pay back a very small amount of money without admitting liability T he Director asked inappropriately personal questions.I was accompanied and supported by my non legal spouse I still resent the unfairness of the system And by the way my advice and understanding is even if you are cleared under the legislation the PSR Officers are unable to be sued Not really a level playing field !! Where is the AMAMM RACGP AND RDAA ON THIS?
Anchita Karmakar
Member
Anchita Karmakar
4 months 19 days ago

John unfortunately although the organisations you mentioned above all want the best for their members, they are often in an awkward position because some are mentioned in the legislation itself where they help appoint the PSR Director and or the PSR Committee members/Determining Authority. Its a tricky situation.

Thus other professional organisations who are impartial to this process are fighting hard with court challenges and we are also trying to get a royal commission into PSR.

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