Why Does PSR Target Small Infractions While Ignoring Multi-Million Dollar Alleged Medicare Fraud?

The Professional Services Review (PSR) plays a crucial role in maintaining the integrity of Medicare billing in Australia. Its stated mission is to investigate inappropriate practices and ensure taxpayer dollars are used correctly. However, recent cases raise serious questions about the priorities of PSR enforcement. While some GPs face penalties for minor infractions—such as exceeding the telehealth consultation cap by a single call—large-scale alleged Medicare fraud worth millions reportedly goes uninvestigated.

The Discrepancy: A Case of Priorities?

Doctors and healthcare professionals have noticed a troubling pattern. Reports have surfaced about a multi-million dollar alleged Medicare fraud that has been reported multiple times to Medicare, yet no action has been taken. This concerns a Telehealth company that proclaimed most of Australia a disaster zone, bypassing the ‘established relationship’ rule for telehealth. This is particularly concerning because everyone in the community knows about it—it is an open secret. If frontline medical professionals, practice managers, and patients know, why does PSR remain unaware or uninterested?

At the same time, individual GPs are being subjected to intense scrutiny for minor breaches. One such case involves a GP facing PSR action for exceeding the telehealth consultation limit by a single consult—an oversight that did not harm patients, nor defraud the system in any meaningful way. The severity of the response in comparison to large-scale alleged fraud cases is raising eyebrows.

What is the PSR’s Explanation?

We posed this question directly to Associate Professor Antonio Di Dio, Director of the PSR:

Why is a GP who exceeded the telehealth cap by a single consultation being penalized, while large-scale alleged Medicare fraud—reported multiple times and widely known in the community—remains uninvestigated?

If the entire healthcare community is aware of the situation, why is PSR not paying attention? Why does PSR dedicate resources to auditing individual GPs over minor infractions but seemingly ignore a fraud case that has been flagged multiple times?

Transparency and Public Confidence

The medical community and the public deserve clear answers. If PSR focuses its resources on minor infractions rather than major alleged fraud, it risks eroding trust in its purpose. Is this a matter of misplaced priorities, lack of resources, or something else? If a fraud case has been reported multiple times and nothing is happening, it raises even more concerns.

Conclusion: A Call for Fair Oversight

The PSR is responsible for ensuring compliance, but its actions must be proportional and fair. Investigating minor errors while ignoring large-scale alleged fraud sends the wrong message. If Medicare is losing millions through fraudulent claims, the public needs to know why those responsible are not held accountable.

Next Steps

• Will PSR respond to these concerns?
• Will large-scale alleged fraud cases finally receive proper investigation?
• Is there a systemic issue with how PSR selects its targets?

We invite PSR Director Antonio Di Dio and the Department of Health and Aged Care to respond. Transparency is essential, and the Australian public deserves an answer.