Behind the doors of a PSR investigation

4 minute read

Doctors are reluctant to talk about being investigated by the PSR, and after one shared his story with TMR, it’s easy to see why.

Doctors are reluctant to talk about being investigated by the PSR, and after one shared his story with TMR, it’s easy to see why.

When ophthalmologist Dr David Kitchen was asked on the ABC’s 7:30 about his investigation by the Professional Services Review (PSR), his responses were often chilling.

“I fought it because I’d done nothing wrong,” he told 7:30, “getting up at 2:00am before work, 7:00pm till midnight, weekends, I didn’t go on family holidays. It dominated my life for four years.”

The interview formed part of Nine Newspapers and the ABC’s “investigation” of inappropriate Medicare billing to the tune of $8bn. That figure was scorned by senior figures from throughout the medical community, while recently Health Minister Mark Butler rejected it entirely.

The PSR’s investigation of Dr Kitchen was eventually struck down in February 2021 when the Federal Court quashed former PSR director Professor Julie Quinlivan’s decision to establish a PSR committee. That blunder not only voided the committee’s deliberations but also its very existence.

Getting a sense of how the PSR – Medicare’s investigative arm – operates is nigh on impossible.

Given the distress and professional humiliation experienced by practitioners who are selected for investigation by the secretive agency, the case for putting it under a very bright spotlight is undeniable.

But doctors are reluctant to talk about it, while revealing the determinations of a PSR committee, except in very limited circumstances, is prohibited by law. To do so risks criminal prosecution and 12 months’ jail.

So, for the moment, what went on between Dr Kitchen and a committee to which he was referred contrary to the Health Insurance Act, will remain under wraps.

The 17-minute ‘review’

Dr Kitchen, a consultant eye specialist for over 20 years, is the only full-time resident ophthalmologist in Central Queensland.

The Health Department began investigating him in June 2017 because of the large number of cataract surgeries he had performed the previous year compared to prior years, and in comparison with his peers. This was easily explained, since he had set up a centre to provide a bulk-billing cataract surgery for patients who would normally have trouble paying for the procedure. Many of these had been on long waiting lists with Queensland Health.

Understandably, the high-volume service which was established led to his being queried by Medicare for possible inappropriate practice.

Dr Kitchen had an initial phone interview and subsequently provided a 62-page submission to explain his billing patterns. But Medicare still wasn’t satisfied their concerns had been met and in December 2017, the Medicare chief executive asked the PSR director, Professor Quinlivan, to investigate his provision of MBS services between 1 February 2016 and 31 January 2017.

The director commissioned a report on Dr Kitchen by an ophthalmology peer, but this report expressed concerns about only three of Dr Kitchen’s attendances among the 110 attendances the director referred to him.

In August 2018, Dr Kitchen received the director’s report of the meeting and was invited to make a submission in response. That response comprised 929 pages with 207 attachments. Under the Health Insurance Act, the director must take this submission into account before taking any further action.

At 4:05pm on 6 November 2018, the PSR case manager emailed the submission, with a 1,200-word covering email of her own, to Professor Quinlivan. At 4:22pm – just 17 minutes later – she responded, noting that she intended to establish a committee and was “inclined to refer everything and the Committee can then refine as they see fit”.

That decision to establish a PSR committee without considering Dr Kitchen’s detailed submission, would, once discovered, be the nail in the coffin as far as the PSR’s investigation of Dr Kitchen went.

On 2 February 2021, the Federal Court’s Justice Collier declared that as director, Professor Quinlivan didn’t take into account Dr Kitchen’s submission before referring him to a committee under the Health Insurance Act and therefore her decision was void. Also void was her decision in November 2019 to fully disqualify him from access to MBS payments.

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