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Avoiding the Next Robodebt

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I questioned the Minister regarding Schedule 1 of the Health Legislation Amendment (Miscellaneous Measures No. 1) Bill 2025, specifically the automation of Medicare Provider Numbers (MPNs).

My primary concern, as always, is ensuring that “automation” isn’t just a fancy word for another government digital disaster. We’ve seen the Robodebt fiasco, the Bureau of Meteorology website fiasco, Australia Post software fiasco and the Border Force Cargo management automation fiasco; my job is to make sure Australians aren’t the next victims of a “government stuff-up.”

I asked the Minister why legislation is needed for a process that is already using computers. She replied that this bill provides legislative support for existing practices and introduces safeguards, adding that computers will not be used to revoke or suspend provider numbers without a human request.

I asked if this automation of MPNs was a “Trojan horse” for Artificial Intelligence (AI). Despite the Explanatory Memorandum mentioning “computer programs” for non-discretionary decisions, the Minister stated on the record that there is no intention or requirement to use AI for allocating MPNs.

Finally, I sought clarification on changes to Commonwealth supported places. Under the new rules, medical students who withdraw from their degree, even late in their studies, will no longer be forced to repay the scholarship cost (though they remain liable for HECS). The Minister said that this is about “fairness” rather than recouping funds from students facing hardship.

I remain sceptical of any move toward “automated” government software, and I will be monitoring these automated systems very closely.

Transcript

Senator ROBERTS: Minister, schedule 1 of the bill automates the issuance of Medicare providers numbers, MPNs. ‘Automation’, I assume, means computer software. Computers are used now for the process. What is different about the process being proposed that it requires legislation to enact it?  

Senator McALLISTER (Minister for the National Disability Insurance Scheme): Thank you for your patience, Senator Roberts. I was just obtaining advice so I can advise you correctly. This new part of the act will ensure that the system can approve the use of a computer program for certain decisions relating to the allocation and management of Medicare provider numbers. It will not—and this, I think, will be important to you—enable the approval of the use of a computer program to make decisions about revoking a Medicare provider number or suspending a Medicare provider number where the suspension is not at the request of a health professional.  

It will also include safeguards around the use of computer programs to make decisions relating to Medicare provider numbers. Those safeguards include a requirement to notify a person where a computer program was used to make a decision about their Medicare provider number; a requirement to make it public when the use of a computer program to make decisions about Medicare provider numbers has been approved; a power to make substitute decisions where they are satisfied that a decision made by the operation of a computer program is incorrect; and a requirement to include information in the Services Australia annual report about the number and types of substituted decisions. 

Importantly, these things introduce safeguards, and they also, as is indicated in the explanatory memorandum, provide legislative support for an existing practice where some Medicare provider numbers have been allocated by use of a computer program, rather than by a human delegate.  

Senator ROBERTS: I think you anticipated one of my future questions, but, in the meantime, who decides if a person is qualified for a Medicare provider number, including the decision to give a Medicare provider number to a new arrival in the country? I’m asking this to see how this automation will impinge on the process of determining qualifications.  

Senator McALLISTER: May I clarify. I think what you’re asking is, ‘How would a new migrant to Australia have their qualifications recognised for the purpose of practising in an Australian context?’ Is that correct?  

Senator ROBERTS: That’s part of the question. The other part concerns any Australian who’s here right now; how would they be qualified?  

Senator McALLISTER: I’m terribly sorry. I might ask you to clarify further. You said that you’re asking about how a person who is here now would obtain a Medicare provider number. Do you mean an Australian citizen or another person? What are you trying to elicit from me?  

Senator ROBERTS: Anybody who’s qualified to get a Medicare provider number—how would you make sure they are qualified, and how would you make sure that we’re not excluding people?  

Senator McALLISTER: The advice I have is that the bill that’s before us doesn’t change any of the existing arrangements. Those arrangements, of course, include a series of processes to ensure that a person seeking to practise within the Medicare system is qualified.  

Senator ROBERTS: How extensive are the checks, and is there any hint of automation being more than just computer software? Is the bill intending to allow for the use of AI for automatic MPNs?  

Senator McALLISTER: No.  

Senator ROBERTS: So there’s no requirement for artificial intelligence to be used in allocating MPNs?  

Senator McALLISTER: The advice I have is no.  

Senator ROBERTS: I’ll quote from the explanatory memorandum:  

The Bill will enable the Chief Executive Medicare to approve the use of a computer program to make appropriate, non-discretionary decisions relating to the registration and claims process.  

Can I confirm you intend to use AI for that process? If so, what checks are in place to make sure the AI is fit for purpose?  

Senator McALLISTER: The advice I have in relation to AI is that there is no intention. We do not require AI to perform the functions that are set out in the bill. In relation to your earlier question about the process by which a person becomes eligible for obtaining a Medicare number, the Parliamentary Library’s Bills Digest in relation to this says:  

To be eligible to provide a Medicare service, health professionals must meet certain criteria. Practitioners eligible to have Medicare benefits payable for their services ‘at the place of practice as well as refer patients to other health professionals for Medicare eligible services, such as pathology and diagnostic imaging from the place of practice’, may apply online or in writing to Services Australia for a MPN for the locations where these services/referrals/requests will be provided.  

MPNs are used by health practitioners both ‘as a means of identifying themselves and their place of practice for the purposes of claiming Medicare benefits for eligible services, and as an identifier to support other Medicare-related programs …  

Senator ROBERTS: To clarify for constituents and to get some reassurance: you didn’t hesitate when you used the word ‘intention’ with regard to AI and then said there was no requirement. After the robodebt fiasco, the Bureau of Meteorology website fiasco, the Australia Post software fiasco and the Border Force cargo management automation, constituents have every right to point out that these stuff-ups keep happening because of the way in which new technology is rolled out. That’s a big concern. Now you’re giving the software decision-making powers, and it sounds like there are no plans to do that with due care. What security steps are being taken to reassure our constituents that the automations proposed in this bill don’t become yet another government stuff-up? I acknowledge that not all of the stuff-ups have occurred on your watch. 

Senator McALLISTER: This bill puts in place safeguards to ensure that, to the extent that a computer is utilised, the circumstances in which a computer is being used are made very explicit. It also puts some constraints around the kinds of decisions that may be taken by a computer in the context of this process—that is, the process of obtaining a Medicare provider number. I read to you earlier some of those safeguards, which are set out in the explanatory memorandum. As I indicated to you, the advice I have is that this process, which involves the use of a computer for certain purposes that are quite tightly defined and constrained, does not require the use of AI.  

Senator ROBERTS: This final question has a lengthy preamble. Item 3124ZH1 removes the requirement for students who do not complete their degree to repay the Commonwealth supported place cost. Students can currently withdraw from the program without consequence up to the HECS census date in their second year of study. If the student withdraws after that date, they incur a debt to the Commonwealth equal to the full cost of their Commonwealth supported place up to the date of withdrawal in addition to any HECS or HELP liability. The proposed amendment, as I understand it, seeks to extend the existing grace period from the HECS census date in the second year of study to the award of the medical degree. Can you please explain that provision? It sounds like they can pull out right at the end of their degree and not have to pay back the cost. Is that right?  

Senator McALLISTER: Senator, you’re correct that at the moment a person who withdraws from their degree doesn’t need to pay the cost of the scholarship back if they withdraw prior to the census date you alluded to. I believe that they do remain liable for the HECS costs incurred by them in the pursuit of their studies up to that point. You are also correct that a purpose of this bill is to extend the period during which a person may withdraw without incurring a debt associated with their receipt of Commonwealth payments.  

Senator ROBERTS: Sorry, that was my second-last question; I’ve got another one now. What is the rationale behind extending the withdrawal date so they won’t have to pay it back?  

Senator McALLISTER: Earlier in the debate I read out an email from a person who has incurred a debt in precisely these circumstances, and they spoke about the hardship they had experienced as a consequence of that. This person made the point that the purpose of the bonded nature of this program is to ensure that people who do qualify as medical professionals fulfil their obligation to work in an area that is underserved by medical practitioners. The purpose is not in itself to recoup funds from students, and we simply seek to make the system fairer. 

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Breaking the Silence: AHPRA’s Grip on Healthcare

I was invited to speak at ‘The Misdeeds of AHPRA’ conference held in Sydney on Saturday, 3 May 2025. As it was election day, I couldn’t attend in person and was asked to pre-record a video, which I happily did.

My brief video exposes the many serious conflicts of interest among Australian Health Practitioners Regulation Agency (AHPRA) board members. The conference organisers used it to open the day.

AHPRA faced heavy criticism during the COVID period. Established in 2010, AHPRA was meant to be an independent body overseeing medical practitioners. Yet its board members are deeply intertwined with government and academia, raising questions about its independence.

Recent surveys by the Australian Medical Professionals Society (AMPS) reveal that over 82% of healthcare professionals believe AHPRA lacks fairness and transparency. Investigations drag on for years, causing significant mental and financial strain on practitioners.

AHPRA’s actions during the COVID period, including prosecuting medical professionals for speaking out truthfully to their patients and the public, have eroded public trust and severely crippled our healthcare service.

It’s time for a thorough review and reform to restore confidence in our healthcare system.

Transcript

Hello, I’m Senator Malcolm Roberts, Senator for Queensland with One Nation.

Thank you for the work you’re doing at this conference.

AHPRA (Australian Health Practitioner Regulation Agency) was heavily criticised during the COVID period. And deservedly so. For those at home, I’ll give a quick background to AHPRA.

The national scheme for registration and regulation of medical practitioners that the Australian Health Practitioners Regulation Agency (AHPRA) administers, was implemented in 2010 under the Rudd-Gillard-Labour Government. The so called national law is not a Commonwealth law. Instead it is implemented by each state passing the same legislation, with Queensland acting as the host jurisdiction.

Any proposed amendment to the national law must be approved by the Council of Health Ministers, then passed by the Queensland Parliament, then other states. In 2010 the Federal Government legislated to recognise medical professionals licenced by AHPRA to prescribe under Medicare and the PBS.

AHPRA replaced state based powers with a national independent system of registration and standards for practitioners. AHPRA now hosts fifteen boards, each regulating one area of the medical profession.

AHPRA act as the independent administrator and the boards are the policy makers in their own area. Except that AHPRA is not independent.

AHPRA Chair – Miss Gill Callister – doubles as the Chief Executive Officer of Mind Australia, a commercial operation which provides mental health services, including under the bloated NDIS.

Mind Australia receives additional funding directly from state and federal governments. Board member – Miss Barbara Yo – doubles as Chief of Monash Health, a Victorian government department. In other words, a public servant.

Ari Freiberg is an Emeritus Professor of Law at Monash University, which receives half a billion dollars a year from the federal government. Linton Morris is on the board of Alfred Health, another public servant, as is Geoffrey Moffat, who’s on the board of WA Country Health. And so it goes on and on.

Everyone of the AHPRA board is an academic funded by the government, or is a bureaucrat funded by the government.

How can these people be considered independent? They are NOT independent.

As Kara Thomas pointed out in a January Quadrant article, the recent Bay versus Australian Health Practitioner Regulation Agency court judgement specifically noted that while the pandemic was “an extraordinary period of history,” it did not authorise AHPRA to “abrogate the right of persons to a hearing before an apparently unbiased tribunal.”

Or extend AHPRA’s role to “include protection of government and regulatory agencies from political criticism.”

That’s exactly what AHPRA did.

The spawn of the medical establishment rushed to defend the medical establishment at a terrible cost to the public’s confidence in the medical industry.

The Australian Medical Professional Society (AMPS) recent survey of medical practitioners found 82.6% of healthcare professionals believe AHPRA lacks fairness and transparency in handling complaints and 78.5 percent report unfair treatment.

Unfair treatment!

These numbers reveal and represent AHPRA damning failure. Unfair treatment includes investigations that last for years, career destroying delays and devastating financial and mental health impacts, including suicides.

Many health professionals contemplate leaving the profession entirely.

The acceptance of anonymous complaints and the punitive nature of investigations without proper vetting has created a culture of fear where doctors have said they now practise risk averse defensive medicine, which is not medicine.

This is not incompetent – it’s deliberate. The culture of fear has been created to rob medical professionals of their will to practise medicine in the best interests of the patient.

This is the opposite of care.

Instead, AHPRA has engineered a situation where doctors practise in the best interest of the pharmaceutical industry that AHPRA works for. One example of this is the way in which AHPRA looks the other way when 1500 Australians die every year from an overdose of a medication prescribed by one of Australia’s 88,000 prescribing medical professionals.

In the last 12 months AHPRA prosecuted 31 people. Only two of these relate to prescription drugs of any kind. And yet in Senate estimates, AHPRA advised me they had prosecuted 21 medical professionals for speaking the truth about COVID.

AHPRA prosecuted one practitioner in part for their anti trans position. AHPRA is fighting a rearguard action against the overwhelming shift in public attitude away from invasive medical procedures on children.

Why? Because this will be a billion dollar industry next financial year. If you want the best pronunciation of AHPRA, try this one: cha-ching, cha-ching, cha-ching – the cash registers tune.

During Senate estimates, I asked AHPRA about their cultural safety strategy, which requires all registered health practitioners to acknowledge colonialism and systemic racism.

This is politics, not medicine. Wherever power has been consolidated into a single body, their power has grown.

They become a beacon for every self interested pharmaceutical company, attracting staff prepared to behave in the most egregious way in return for power and a public service salary.

A Senate review in 2022 made fourteen recommendations, including an urgent, in depth review of their processes. That review has never happened. None of the recommendations have been actioned.

Kara Thomas’s article in Quadrant contained a set of sensible recommendations, including devolving these powers back to the States. One Nation supports each of her recommendations.

In short, AHPRA is a failed, corrupting and destructive experiment and must be shut down immediately.

I’ll give the last word to Ms Callister, AHPRA’s Chair, who reposted this tweet in 2018 – “Power comes at a price. Those in the top job have made many compromises to get there”.

Clearly those compromises include absence of professionalism, care, accountability, fairness, decency, transparency, honesty and independence.

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Scrap Net Zero, Stop Waste, Restore Australia

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Australia watched the Treasurer turn the cabinet room into a stage for business and union bosses instead of using it for real cabinet deliberation. The roundtable wasn’t about shaping policy—it was about rubberstamping what the government had already decided. Their attempt to link productivity to higher taxes collapsed, and Australians are left wondering why this government keeps chasing revenue instead of fixing its spending problem.

One Nation will fight the Albanese government’s tax hikes and end the wasteful net zero transition that’s draining billions a year while driving private enterprise away. We will restore fiscal sanity by cutting unnecessary spending, imposing an eight-year residency requirement for Social Security, and cracking down on fraud in agencies such as Centrelink, Medicare, the NDIS, and the PBS.

Smaller government and a sensible energy policy will deliver real productivity gains and prosperity for Australians—especially our young.

Transcript

Last week, Australia watched the Treasurer host business and union bosses in the cabinet room. The irony escaped the Treasurer—using the cabinet room to hold a policy debate cabinet itself should be doing. The usual suspects were not there to help form government policy; they were there to rubberstamp the policies the government intends to implement in this parliament. The roundtable even failed to achieve that. We know this because the ABC leaked the outcome of the week before. That communique remains in Treasurer Chalmers’s drawer, abandoned and unloved. The core intent—making productivity about taxation—failed.  

One Nation will oppose the tax hike the Albanese government will still try to introduce to cover its growing financial black hole caused largely through the increasing use of taxpayer money to pay for a net zero transition from which private enterprise is walking away—indeed, running away. This government doesn’t need more revenue; it needs to spend less money. One Nation will abolish the net zero transition, saving the government $30 billion each year in direct expenditure and generating that much again in extra revenue from a revitalised economy. One Nation will impose an eight-year residency requirement on access to social security, taking tens of billions of dollars off the cost of Centrelink, Medicare, the NDIS and the PBS and giving auditors and police a chance to investigate and prosecute the rampant fraud. Net zero insanity, deficit spending and throwing cash at new arrivals are robbing our children of their future.  

Smaller government and a sensible energy policy are where productivity improvements will actually come from. One Nation’s policies will restore wealth and prosperity for all who are here, especially our young. The Albanese government will just take your money and leave working Australians with less—much less. A One Nation government, though, will restore Australia. 

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Medicare and Bulk-Billing: One Nation’s Practical Solutions

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Listening to everyday Australians across Queensland, I’ve heard your concerns about the rising cost of health care. When Labor first took over, they increased the Medicare rebate, boosting bulk-billing rates. But by 2025, that effect has faded. According to Cleanbill’s 2025 report, nearly 80% of GP clinics no longer bulk-bill adult patients. The percentage of bulk-billing GPs in Queensland has halved since Labor came to power, and out-of-pocket costs have risen by 9%.

Medicare is crucial for timely medical treatment, helping people get back to work faster. In the US, unpaid medical bills cause 40% of bankruptcies. One Nation won’t let that happen here. One Nation will increase the Medicare subsidy to encourage bulk-billing, funded by cracking down on Medicare and PBS fraud, which costs $3 billion a year. We’ll also delay social security, including Medicare, for new arrivals.

One Nation is committed to practical solutions for the cost-of-living crisis. We’ll reduce overseas student numbers to create more university places for Australians, especially in health disciplines, and expand bursaries for students from rural areas. While Labor offers bandaids, One Nation offers real solutions.

Transcript

In listening to everyday Australians across my home state of Queensland, one of our highest concerns is the cost of health care. This Labor government increased the Medicare rebate when they first took over. It was a long overdue move which increased the rate of Medicare bulk-billing. In 2025 the effect of that increase has worn off, much like the lustre on this government. According to Cleanbill’s 2025 report, nearly 80 per cent of GP clinics no longer bulk-bill adult patients. When Labor came to power, 26 per cent of GPs in Queensland bulk-billed. In 2025 the figure is projected to be 14 per cent—halved. As a result, the out-of-pocket cost of visiting a doctor has risen by nine per cent. 

Any economist can easily make the case for Medicare. As a national insurance policy, it matches medical treatment to the time the person needs it rather than to the time they can afford to pay for it. This optimises health care and gets the person back to the productive economy faster. 

In the United States, unpaid medical bills cause 40 per cent of all bankruptcies. One Nation will not accept that happening here. One Nation will increase the Medicare subsidy to encourage bulk-billing. This subsidy will be paid for through cracking down on Medicare fraud, estimated to cost $3 billion a year. This figure doesn’t include fraudulent loaning out of Medicare cards. Some areas in Sydney have more adults using Medicare cards than they have eligible adults. One Nation will delay the granting of social security, including Medicare, to new arrivals. That announcement will be made separately. One Nation have already announced a policy to reduce overseas student numbers and create more places for Australian children to go to university in areas where Australia needs graduates, which includes health disciplines. One Nation will expand bursaries for students to attend from the bush or to practise in regional and rural areas. While Labor offers bandaids, One Nation are offering practical solutions to the cost-of-living crisis. 

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Professional Services Review Scheme Under Question

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The Professional Services Review was created to review misconduct of health professionals in a Medicare context, commonly invoked where there are allegations of over-servicing or Medicare fraud.

This Committee seems to be a law unto itself.

Dr Di Dio confirmed that there is no appeal process from conclusions of the Committee based on Merit. The only appeals available are based on errors of law that would include taking into account evidence that was not relevant or excluding evidence that was relevant. Lawyer Mr Topperwein confirmed that the weight to be placed on evidence was that which the Committee chose to give. He said that the Committee was both the investigator and the judge of the facts with no appeal on merit.

Mr Topperwein could provide no explanation as to why there were no lawyers on the Committee, to ensure the processes were fair and just, stating that the committee comprises practitioner peers.

The concerns about the Review Scheme being a law unto itself seem to be valid, it looks like we need some serious reform in this area.

Transcript

Chair: I welcome the acting director of the Professional Services Review, Dr Antonio Di Dio. Senator Roberts, is it one block of questions here?

Senator ROBERTS: Yes, hopefully we should get through it in one block.

Chair: Dr Di Dio, do you have an opening statement?

Dr Di Dio: No, thank you.

Chair: Alright. Senator Roberts.

Senator ROBERTS: Thank you, Dr Di Dio, for being here again. During the last estimates hearings I asked some questions, and your answers left me confused. Regarding what you gave me, I was feeling somewhat
misled, potentially, because I reviewed it afterwards. I was concerned by a number of submissions made to me about the lack of fairness of the structure by which this review scheme investigates allegations of misconduct by health professionals in a Medicare context. I’ve since done further research into this area and looked over the transcript closely. Just to start with the transcript, the Professional Services Review scheme was set up to review misconduct of health professionals in a Medicare context, commonly invoked where there are allegations of overservicing or Medicare fraud. Isn’t it true that the committee’s conclusions cannot be challenged on merit as to the accuracy or completeness of the basis for the evidence?

Dr Di Dio: The committee’s conclusions are made after an exhaustive and highly respectful process in which the practitioner under review gives evidence and responses in relation to potential concerns about potential
inappropriate practice, whether it is in the billing of Medicare item numbers or whether it is in conduct in association with the billing. The committee process occurs after an earlier process in which the director, firstly,
decides whether a matter will be reviewed; secondly, undertakes a non-compulsory interview with the practitioner involved; and thirdly, decides whether to take no further action under section 91, or a negotiated agreement or a referral to a committee. At each of those steps the practitioner under review is invited to make their submissions, give their evidence and respond to any preliminary concerns, to potentially make those concerns go away with the additional information that comes from the practitioner’s individual responses to each of those preliminary concerns.

So, even before the committee occurs, the practitioner has ample opportunity to respond. But at the committee stage itself, when the practitioner is reviewed by their peers, the practitioner has a great deal of opportunity to respond in as much detail as they wish about those particular concerns.

Senator ROBERTS: Thank you for that long answer. There were a lot of words there—exhaustive evidence and so on. But the fact is that you did not answer my question. My question said: isn’t it true that the committee’s conclusions cannot be challenged on merit—meaning as to the accuracy or completeness of the basis of the conclusions.

Dr Di Dio: Well, the committee is bound by its own obligations to the act—

Senator ROBERTS: Can the doctor challenge the accuracy or completeness of the evidence presented?

Dr Di Dio: Well, the evidence is presented by the doctor in response to those questions. I think perhaps your question is, can the practitioner challenge the evidence that the committee has before it? Is that what you mean?

Senator ROBERTS: Yes.

Dr Di Dio: The committee issues what’s called a notice to produce to the practitioner to ask the practitioner to produce documents, most typically the medical records of the patients who are being reviewed, for whom the particular services may be of concern. So, that evidence comes from the practitioner.

Senator ROBERTS: And I’ll say it again. The committee’s conclusions cannot be challenged on merit.

Dr Di Dio: I’ll refer you to my legal counsel, Mr Topperwien.

Mr Topperwien: It’s quite right that once a committee has gone through the whole process of providing a draft report and then a final report then any challenge to the findings in that final report must be limited to a
question of law, which includes whether they have taken into account irrelevant considerations or have not taken into account relevant considerations and have held a fair hearing. Those are all questions of law. And a challenge can be made to a committee’s findings on the question of law only. There isn’t an appeal to a merits review body.

Senator ROBERTS: Thank you. So, they cannot be challenged on merit, just on the points of law. What weight is placed on the evidence of witnesses called by the doctor under investigation to challenge the case being
made by the committee?

Mr Topperwien: The weight that a committee will give to any evidence depends on the nature of that evidence and how credible it is, and they are matters for the committee to determine.

Dr Di Dio: I would add to that that the practitioner under review is encouraged very much to bring legal representation, and support persons and witnesses are welcome.

Senator ROBERTS: Isn’t it true that the committee takes the role of both prosecutor and decider of facts that make the conclusions and recommendations of the committee?

Mr Topperwien: That is not true. The committee is not a prosecutor. It is an investigatory body. It investigates.

Senator ROBERTS: And once it’s finished its investigation, who does the prosecution of the case?

Mr Topperwien: There is no prosecution of the case.

Senator ROBERTS: Who makes the decision?

Mr Topperwien: There are findings of fact made—whether or not a practitioner engaged in inappropriate practice. And that is the sole duty of the PSR committee—to make a finding as to whether or not the practitioner engaged in inappropriate practice. The consequence of that finding is not a matter for the committee. It is a matter for a separate body called the determining authority.

Senator ROBERTS: I’m of the understanding that the investigation is done by the committee—

Mr Topperwien: Yes.

Senator ROBERTS: and then it decides.

Mr Topperwien: Yes. It decides whether or not the practitioner engaged in inappropriate practice.

Senator ROBERTS: Right. So, it decides. It does the investigation, and then it makes the verdict on its investigation.

Mr Topperwien: Yes.

Senator ROBERTS: So, it’s investigator, policeman—

Mr Topperwien: No—

Senator ROBERTS: It’s also judge.

Mr Topperwien: No. It’s an investigator in that it is charged with looking at whether or not the practitioner engaged in inappropriate practice. Clearly, if that’s its task then it has to investigate and obtain all the evidence
necessary to determine that question which it’s charged with answering.

Senator ROBERTS: So it does an investigation, then it makes the judgement and there can be no appeal or challenge on the merits of the case.

Mr Topperwien: That’s right, because it is an expert body that parliament has given the role of making those sorts of findings.

Senator ROBERTS: We’ll get to that matter of whether it’s expert or not. Isn’t it true that committee members undergo a training course in prosecution and investigation?

Mr Topperwien: They are not given any training in prosecution. They are given some training in relation to how to fulfil their task of investigating in the context of holding hearings when they question the person under review and take evidence.

Dr Di Dio: They are given further training in asking questions respectfully and appropriately.

Senator ROBERTS: Sounds good. Are they provided training in decision-making and natural justice principles.

Mr Topperwien: Yes, they are.

Senator ROBERTS: They are?

Mr Topperwien: Yes.

Senator ROBERTS: Is there any section of the Health Insurance Act 1973 where cross-examination of the committee’s case is prescribed?

Mr Topperwien: The Health Insurance Act does not mention at any point cross-examination.

Senator ROBERTS: How can the strength of the committee’s case be tested without substantial questioning given that the committee determines its own outcomes based on its own prepared case?

Mr Topperwien: At the hearings that the committees hold, the person under review is entitled to question any witnesses. They are able to present whatever evidence they wish to present to the committee.

Senator ROBERTS: Isn’t it true that any appeals from the committee’s decision are limited to procedural issues and merit review is not allowed? I think you’ve already answered that question.

Mr Topperwien: I’ve answered that question.

Senator ROBERTS: Why is there no senior lawyer or judge as part of the committee to ensure fairness of process?

Mr Topperwien: The reality is the committee is made up of the practitioner’s peers. They are all practitioners but at the committee hearing there are always two lawyers from PSR who are very experienced in administrative law, the rules of natural justice, to ensure that the committee hearing is conducted fairly, and the PUR—the person under review—is encouraged to engaged their own lawyer to be with them throughout the whole process.

Senator ROBERTS: I’ll just come to GPs, for example. There is such a wide range of GP services and, if you like, specialties. They’re not specialists—

Mr Topperwien: They are specialists in being general practitioners, yes.

Senator ROBERTS: Okay, but they focus on a particular area, niche, within—

Mr Topperwien: Some do; that’s right.

Senator ROBERTS: And some GPs cannot understand another GP’s work because they haven’t had the experience or the qualifications, particularly the experience.

Mr Topperwien: We try very hard to ensure that the members who are put onto committees have the relevant experience. As closely as we are able to do from the general practitioners who we have on the PSR panel from whom we can choose members to put on committees, we try very hard to ensure that their experience is such that they can well understand the circumstances and context and the type of services that the person under review provides.

Dr Di Dio: To clarify, you’re quite correct: there are general practitioners who have subspecialties, but we try very clearly to match the subspecialties as much as within reason, through the membership of our panel, to those particular practitioners. Most notably a lot of general practitioners do skin work, and we try to match our panel

Senator ROBERTS: Why is there no independent review process, apart from a limited formal appeal process?

Mr Topperwien: The make-up of the PSR COO committees is such that we have the best practitioners in their specialty appointed to the committees and to the PSR panel in order that we have the practitioners most
appropriate and who we have consulted with the relative colleges in their appointment to ensure that the colleges are confident that these practitioners are ones appropriate to assess the conduct of other practitioners.

Senator ROBERTS: So a GP who could be one of the leaders in the country in his or her field could be swamped with work because hardly anyone else is doing it. There wouldn’t be someone who was capable of
understanding that complete picture?

Dr Di Dio: GPs are generally not stupid. GPs are capable of understanding the work of other GPs. Should a GP be practising in a highly specialised area, we do the best that we can to match our panel of expertise with the relevant practitioner. Further, sometimes GPs may be involved in subspecialist activity where, at a stage even earlier than the committee stage, we might get a specialist in that field to review a case in addition to having a GP review the case. We try as hard as we can to match those skills.

Senator ROBERTS: If the committee refuses to give sufficient weight to exculpatory evidence clear on fault or guilt, where does that leave the doctor if they cannot appeal on merit?

Mr Topperwien: The committee hearings are intended to give the practitioner every opportunity to put whatever evidence they want to give to the committee and the COO. The committee then looks at that in detail
and asks probing questions in relation to that evidence. One can’t satisfy everybody that everybody will agree on an outcome. There will always be people who are not happy with whatever outcome there is. But the process is a very fair process. It gets scrutinised by the courts regularly. The courts time and again have upheld how fair the process has been for the person under review.

Senator ROBERTS: I’d like to learn more about that.

Dr Di Dio: Could I add a supplementary answer to that?

CHAIR: You can in a moment. I remind you that there are a lot of senators waiting to move to the next outcome, so if you could be courteous in the promptness of your questions.

Dr Di Dio: I will be brief. After a committee, the practitioner under review has the right to tender further information and evidence should they wish.

Senator ROBERTS: But not appeal the decision.

Dr Di Dio: No, but tender as much further evidence as they wish. Furthermore, there is a draft report issued, to which the practitioner, with their legal representative, of course, can make any response they wish. After that, a final report is issued, to which the practitioner can again make as many submissions as they wish. Over and over the practitioner can provide further evidence and submissions to further parts of the process.

Senator ROBERTS: Wouldn’t it be a better process for a judge to be advised by doctors, as is the case before QCAT, VCAT and a similar structure used in the Medicare Participation Review Committee? Contrary to
previous suggestions, I’d submit that having a judge to chair review proceedings would enhance rather than detract from the fairness of the process.

Mr Topperwien: All I can say is that’s not what the law currently provides. But, from my experience, both as a legal adviser who has assisted with committees and having observed many committee hearings, the process is remarkably fair. The usually three lawyers in the hearing room ensure that it is a fair process.

Senator ROBERTS: My last question. In 2011 there was an inquiry held by the Legal and Constitutional Affairs References Committee into the Professional Services Review scheme. Supplementary comments by
senators Eric Abetz and Bridget McKenzie included that the processes of the Professional Services Review scheme were deficient and led to unjust outcomes. Senator Abetz’s view was that merit review would be a
mandatory requirement for the system to be considered fair and just. This flies in the face of your own view, that merit review is unnecessary. Minister, when will the structure of the Professional Services Review scheme be reconsidered?

Senator McCarthy: I will take that question on notice.

Senator ROBERTS: Thank you.

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