Paul Smith AusDoc editor

Legislation before Parliament could see its ‘ master ’ lose control .

The claim partly centred on the fact that , although its director is appointed by the federal Minister for Health and Aged Care , Mark Butler , the AMA has the power to say no to the minister ’ s choice .

There is now legislation before Parliament to scrap the veto power .

The AMA is angry ; the RACGP says it has no objections .

For Mr Butler , the arrangement is a blatant conflict of interest .

“ Given the Professional Services Review ’ s ( PSR ’ s ) objective to safeguard Medicare and the AMA ’ s role in representing the interests of medical practitioners who may be subject to PSR review , it is appropriate for the veto power to be removed ,” he says .

But the AMA believes its role as the decider — to echo George Bush ’ s description of his job when leading the Free World — is to protect the medical profession ’ s confidence in the PSR itself .

AMA president Professor Steve Robson stressed recently that the independent review into the ‘ Medirort ’ furore found no evidence that the AMA had “ interfered with its independence or impacted on PSR decision-making ”.

‘ It is appropriate for the veto power to be removed .’

“ Unless strong consultation with the profession about the operation of the PSR continues , … it will become just another regulator

, with little regard for the peer-review process ,” he added .

For those doctors whose lives have been blighted by the PSR , there has never been much confidence in the body .

Along with the highly charged debate around the PSR as a star chamber , there have been numerous legal tussles over the years about its legal legitimacy to police doctors . Although those tussles have largely gone in favour of the watchdog , the one big stuff-up came in 2011 when it emerged the Department of Health had failed to follow due process in the appointment of investigators to the PSR ’ s review committees .

Officials realised too late that it had not consulted with the AMA as required by the legislation .

As a result , 39 ongoing PSR cases were shelved , with the bungle raising fears that PSR decisions against some 40 doctors

dating back to 2005 could be declared legally invalid .

In the end , that did not happen , but it required the Federal Government to introduce retrospective legislation to make the problem go away .

In truth , the PSR has always been a strange legal beast born of compromise . Yes , some doctors rail against its activities .

But its supporters within the medical profession will always say to be careful what you wish for .

Governments have acquiesced to its existence because having a peer-review approach , where doctors look into the billings of their colleagues to identify inappropriate MBS claims ( coupled with a system where things rarely progress much further if the doctor opts to pay back the cash ), is relatively efficient .

In 2021 / 22 , for instance , the watchdog recouped around $ 20 million — not a staggering amount but enough to cover costs and act as a deterrent to others .

The alternative would be to bring in the police to take a look .

This would be high cost for all concerned and one , given the subtle complexities of medical practice , that would risk generating a string of protracted court cases where only lawyers see the money .

So for its supporters , the PSR ’ s existence has ensured criminal prosecutions for Medicare fraud remain a rarity — despite some of the sky-high figures of inappropriate billing you read about and despite cases where the PSR itself has questioned the ability of doctors to twist the space – time continuum to perform the number of consults they have managed to bill .

It will be interesting to see if stripping out the AMA ’ s veto powers has any significant effect on the way the PSR runs . To me , it is being done for no other reason than to show the government has done something in response to the media whirlwinds last year .