Dr Antonio Di Dio has been appointed director of the PSR .

Rachel Carter

describes the Medicare watchdog in

JAMILA TODERAS © THE CANBERRA TIMES / ACM

A private process

While Dr Di Dio wants education

around billing and the PSR , he says the “ nitty gritty details ” of individual cases , like that of the neurologist , must remain secret .

“ Individual reviews quite often involve discussion of patient records . We cannot divulge anything to do with that or divulge the identity of the practitioners we review . “ Their privacy is sacred to us . “ It seems opaque , but it is very

terms of “ deep affection ” and being

much about the privacy of doctors

“ close to my heart ”.

and patients .”

Their relationship began 22 years

A further critic of the PSR ( for

ago , when the GP sat on a Profes-

very different reasons ) is Dr Margaret

sional Services Review ( PSR ) com-

Faux ( PhD ), the lawyer who made the

mittee to review another doctor ’ s

headlines by suggesting that 30 % of

billing for the first time .

Medicare claims were inappropriate

He says the experience was

or fraudulent .

“ absolutely fascinating ”.

In a recent report on spinal sur-

“ Bit by bit , I did more regulatory

gery , Dr Faux and her UK co-author ,

part-time work outside of full-time

Dr Simon Peck , said inappropriate

clinical practice , and I found it inter-

practice was a “ euphemism ” for fraud

esting , stimulating and rewarding ,”

and that the PSR investigated a “ mea-

he tells Australian Doctor .

gre ” numbers of doctors .

“ The PSR became even closer to

They took particular exception to

my heart when I moved to Canberra in

the use of ‘ section 92 agreements ’ —

2005 and got to know the people work-

those negotiated agreements where

ing here and saw how it worked .” It is no exaggeration to say the

Dr Antonio Di Dio .

doctors agree to repay rebates . The perception that they

agency is seen by some doctors as

ensured everything else went away

a source of existential dread . It is meant to ensure that doctors are standing in judgement of other doc-

to account , and it is important we are available at Senate estimates and that they can ask us whatever they

“ There are examples where a mistake is absolutely unacceptable because it might involve poor

Asked about the neurologist ’ s case , he says : “ I honestly cannot comment on individual cases .”

after having had a hand in the till meant they were “ not an effective deterrent to misconduct ”.

tors when it comes to the complex

want to ask us ,” he says .

patient care , an enormous amount

Asked whether most cases

Dr Di Dio ’ s response : “ Inappro-

business of Medicare billing , given

But his response was unequivocal ,

of money or no mitigating factors ,”

involve mistakes or not , he would

priate practice is very different

that billing is underpinned by real-

telling Senator Roberts that the accu-

Dr Di Dio says .

not comment .

from fraud in our view .

world medical decision-making .

sation was “ spectacularly untrue ”.

“ Then there might be exam-

But he says at least some doc-

“ If a practitioner makes an honest

But it is routinely attacked for being

As for his peers , he says : “ There

ples where mistakes are deemed

tors act on bad advice .

mistake in a small part of their over-

an affront to the Australian Constitu-

is also a perception [ among doc-

acceptable .

“ Quite often , people engage in

all billing , I do not see that in any

tion ( those clauses about civil conscrip-

tors ] that the PSR is a bunch of base-

“ Whether they are deemed

inappropriate practice not because

way as fraud .

tion ), as well as being branded a star

less , non-clinical people who make

acceptable or unacceptable depends

they are malignant , fraudulent

“ I see that as an honest and

chamber , a sinister kangaroo court

opaque and incomprehensible deci-

on the view of your peers .

or evil — they are just good peo-

decent person who has made an

from which doctors rarely emerge ,

honest mistake .

one that is seen as destroying not just careers but lives .

As a result , there have been numerous legal cases examining claims as to its legality , although the fact that it is still in business gives a rough idea of the perspective the higher courts have taken . None of this history is lost on Dr Di Dio ; he

‘ If a practitioner makes an honest mistake in a small part of their billing , I do not see that as fraud .’

— Dr Antonio Di Dio

“ And what is ‘ unacceptable to the general body of one ’ s peers ’ is still very different to what might constitute a criminal offence .”

In “ egregious ” cases , practitioners will likely repay 100 % of the initial billings , Dr Di Dio says .

But mitigating factors , including practitioners showing they have

knows the PSR is divisive .

learnt from the experience , can lead

Despite this , he says his colleagues

to repaying a lesser amount .

were “ unbelievably supportive ” of

sions about whether someone has

“ I think billing the same item

ple who have not been advised

“ A repayment of $ 500,000 might

him taking the director ’ s role .

done the right thing or not .

1000 times without checking the

correctly .

be based on an initial billing of far

“ Even those not necessarily pos-

“ That could not be further from

rules would be a good example of a

“ It still may be unacceptable ,

more than that , but there were pos-

itively disposed to the PSR are very

the truth .”

mistake that might be less likely to be

but it does not reflect at all on the

itives that we took into account and

much aware that it needs to exist ,” he says .

“ They have all been wonderful about it .”

‘ We need to be held to account ’

Away from the medical profession ,

Inappropriate practice ?

Dr Di Dio has a clear view of the

PSR ’ s remit : to investigate inappropriate practice and address conduct that the medical profession or relevant specialty would deem “ unacceptable ”.

acceptable to your peers than others .”

Some examples of claiming that have been investigated by the PSR are made public .

For instance , this year , a PSR committee ordered a neurologist to repay $ 1.5 million , including for altering EEG referrals to access higher rebates .

character of that person ,” he adds .

“ I see plenty of people here that I am confident are never coming back again .

“ They are clearly good and ethical practitioners who have just erred and may have been taught the wrong thing .”

reached a much lower figure ,” he says .

Inevitable stress

Last year , a government review of

the PSR ’ s section 92 agreements finally surfaced .

Conducted back in 2022 , it

the PSR also counts some right-wing

For the 100 or so practitioners

It prompts the question : to what

He does not agree that Medi-

rejected claims from within the

politicians as critics .

referred by Medicare to the PSR , the

extent could that ever be a simple

care ’ s complexity is to blame ,

profession that doctors were

At a 2023 Senate hearing , One

first step is a review with Dr Di Dio

mistake or misjudgement . Is it not

although he says doctors deserve

“ coerced ” into making repayments ;

Nation Senator Malcolm Roberts

personally . Around 70 % of referrals

something else ?

ongoing training on billing .

however , multiple submissions

attempted to take Dr Di Dio to task

end with an agreement between him

Dr Di Dio says the PSR does not

“ I graduated in 1990 , and I

raised the intense and prolonged

by claiming that PSR committees

and the practitioner to repay inappro-

investigate fraud .

remember growing up in Sicily ,

distress the PSR process could

were completely unqualified to pass

priately claimed Medicare rebates .

“ We do very occasionally get things

Italy , and I think Medicare is won-

inflict on the lives of doctors .

judgement on “ high-level pioneer-

Some 10 % result in no regula-

that we consider to represent fraud ,

derful ,” he laughs .

The report downplayed this ,

ing specialists ”.

tory action at all . And around 20 %

but they are referred back to Medi-

“ But I think there is education

saying stress was an “ inevitable ”

Dr Di Dio had no problem with

are referred to a PSR committee that

care because we do not have the power

required around billing , and I have

consequence of the process .

being challenged .

includes at least two members of the

or authority to investigate fraud ,” he

been actively advocating that in

But Dr Di Dio says the potential

“ People like me need to be held

practitioner ’ s profession .

says .

the past couple of years .”

impact on doctors ’ lives is

PAGE 8