What happens after a Referral is successfully challenged in the Federal Court?
If the Federal Court rules that the Referral is invalid for jurisdictional or other error, the Director of Professional Review Scheme and the members of the Professional Review Committee cannot continue with the Referral. The Director of Professional Review Scheme can only issue a fresh referral in respect of a period not exceeding two years prior to the date of issue. • What is the 80/20 rule? Under the Health Insurance Act 1973 read in conjunction with the Health Insurance (Professional Services Review) Regulations 1999, if during a particular period, the circumstances in which some or all of the referred services were rendered or initiated constituted a prescribed pattern of services, the conduct of the person initiating the services is taken to constitute engaging in inappropriate practice. Prescribed pattern of services is defined in the Regulations as circumstances in which 80 or more services are rendered on each of 20 or more days in a 12 month period.
