Director, Professional Services Review v Yoong

This appeal concerned a Professional Services Review of a Brisbane doctor, Dr Matthew Yoong, under the Health Insurance Act 1973 (Cth). The review was triggered after a delegate of the Chief Executive Medicare asked the Director of Professional Services Review to examine services Dr Yoong provided during the period from 1 May 2017 to 30 April 2018.

The request was driven by statistical concerns about billing and prescribing patterns. The judgment records that the concerns related to specified Medicare Benefits Schedule items and were framed broadly as possible issues about whether some services were clinically relevant or met all item requirements. The Director then decided to undertake the review and notified Dr Yoong that the review could extend to any or all services provided during the review period, and that the Director was not limited by the reasons given in Medicare's request.

Shortly afterwards, the Director issued a compulsory notice under s 89B. It required Dr Yoong to produce complete clinical records for 76 named patients. The notice did not ask only for extracts from the review period. Instead, it sought complete files for those patients, including progress notes, health summaries, pathology and diagnostic imaging reports, specialist and allied health referral letters and reports, hospital discharge summaries, and health assessment and chronic disease management documentation where applicable.

That breadth was the heart of the dispute. Dr Yoong argued that the notice went beyond the statutory power because it was not confined to documents relevant to the review. Since complete patient files could include records from many years before or after the review period, he challenged the notice in judicial review proceedings. His failure to comply with the notice had also led to a further notice under s 106ZPM, which has serious consequences for Medicare benefit payments.

The Full Court spent time setting out the statutory scheme, and that context is important for understanding the decision. Part VAA of the Health Insurance Act establishes the Professional Services Review scheme. Its object is to protect the integrity of Commonwealth Medicare, dental and pharmaceutical benefits programs, while also protecting patients and the community from risks associated with inappropriate practice.

The scheme has several stages. The Chief Executive Medicare can ask the Director to review the provision of services by a practitioner during a specified period. If the Director decides to undertake the review, the Director may review any or all of the services provided during that review period and is not limited by the reasons given in the original request. After the review, the Director may take no further action, enter into an agreement with the practitioner, or refer the matter to a Professional Services Review Committee for investigation.

Section 89B is the key provision in this case. It allows the Director, for the purpose of undertaking a review, to require the production of relevant documents. The statutory definition says relevant documents are documents relevant to the review and includes clinical or practice records of services rendered or initiated during the review period. The notice must also state the period and place for production, and the period must end at least 14 days after the notice is given.

The judgment also explains the significance of s 106ZPM. If a person under review intentionally refuses or fails to comply with a notice under s 89B within the specified period, Medicare or dental benefits are not payable in respect of later services rendered or initiated by that person, or by certain associated practitioners, until compliance occurs. The Director must then give a notice to that effect. That is why disputes about the validity of a notice can have immediate business consequences, not just legal ones.

The central question was whether the Director's notice was authorised by s 89B. More specifically, the Court had to decide what counts as relevant documents in this setting. Could the Director require complete clinical records for named patients who received services during the review period, even though those files might contain entries from before or after that period?

The primary judge had answered that question against the Director. The notice was held invalid because it was not confined to documents relevant to the review. On appeal, the Director argued that this approach was too narrow and misunderstood both the statutory definition of relevant documents and the practical function of the review process.

There was also a second issue about the face of the notice itself. Dr Yoong argued, and the primary judge had accepted, that the notice did not sufficiently disclose that the Director was entitled to require the documents sought. So the Full Court had to consider not only the scope of the power, but also whether the notice identified the documents with enough clarity and showed that the Director was acting within power.

The Full Court allowed the appeal. It held that the documents required by the notice, being complete clinical records for identified patients to whom Dr Yoong provided services during the review period, were relevant to the review within the meaning of s 89B(1), properly construed.

The Court's key formulation was that it could not be said those documents had no conceivable relevance or no bearing whatever on the review of services provided during the review period. The records were likely to assist the Director in performing investigative functions under Part VAA. That reasoning is important. The Court did not treat relevance as confined to a strict date filter. Instead, it accepted that a complete patient file may help the Director assess services rendered during the review period, even if the file also contains earlier or later material.

The Court also held that the form and content of the notice were sufficient. In particular, the documents sought were identified with enough clarity to enable Dr Yoong to understand what he was required to produce and to show that the Director was authorised to require those documents. The fact that the notice did not itself explain the patient selection process did not prevent the Court from upholding it on the facts before it.

As a result, the Full Court set aside the relevant orders made below, dismissed Dr Yoong's judicial review application, and ordered that he pay the Director's costs of the appeal and the proceeding below, subject to a short process allowing either party to seek variation of the costs order.

The most useful part of the case for practitioners is the Court's treatment of relevance. Businesses often read compulsory notice powers narrowly and assume that if a review period is defined by dates, every requested document must also be created within those dates. This case shows that approach can be wrong.

Section 89B refers to documents that are relevant to the review, and then says that this includes clinical or practice records of services rendered or initiated during the review period. The Full Court's reasoning indicates that the inclusive wording does not force an artificially narrow reading. A complete clinical record for a patient may shed light on whether a service during the review period was clinically relevant, whether item requirements were met, or whether the surrounding clinical context supports the billing pattern under examination.

That matters in real practice settings. A patient file may contain referral history, prior diagnoses, treatment progression, imaging results, discharge summaries, and later follow-up material that helps explain what happened during the review period. The Court accepted that such material can have a sufficient connection to the review even if some entries sit outside the review dates.

For healthcare businesses, the practical message is that relevance under s 89B is functional, not merely chronological. If the patient is identified because they received services during the review period, the Director may be able to seek the complete file where that file is likely to assist the review. A business considering whether to resist a notice should therefore focus carefully on the statutory connection between the documents sought and the review task, rather than relying only on the fact that the records extend beyond the nominated dates.

This decision is most relevant to healthcare businesses that bill Medicare and hold detailed patient records. It is not a general records case for all industries. It is also not a privacy case in the ordinary sense, although privacy and confidentiality still need to be handled carefully when responding to compulsory notices.

For a practice owner, the case highlights four operational points. First, a compulsory notice under the PSR scheme should be escalated immediately. It is not routine correspondence. Secondly, the scope of responsive material may be broader than the review dates suggest. Thirdly, the business risk of non-compliance can be severe because of the Medicare payment consequences under s 106ZPM. Fourthly, technical challenges to a notice may fail if the documents sought have a real connection to the review and the notice is sufficiently clear.

The case also shows the importance of record systems. A practice may need to locate long-running files, archived material, and records held in different systems or by third parties. The notice in this case expressly required the practitioner to say if documents were not in his possession, custody or control and could not be obtained, and to provide contact details for another person who held them if known or readily discoverable. That means a business response needs both legal analysis and disciplined document management.

If your clinic receives a notice like the one in this case, start with the wording of the notice itself. Identify the named patients, the categories of documents requested, the place for production and the deadline. Then map those requests against your systems, including clinical software, scanned correspondence, imaging and pathology interfaces, archived records and any offsite storage.

Next, separate legal scope questions from practical production questions. A business may have concerns about validity, but it still needs to understand what documents exist, where they are, and whether they can be obtained in time. If some records are held by another provider, contractor or storage service, that should be investigated immediately. The statutory scheme specifically contemplates situations where the recipient does not have possession, custody or control of all documents.

Practices should also preserve records once a notice is received. Do not alter file contents, backfill notes, or make undocumented changes to metadata. If explanatory context is needed, provide it through an appropriate covering communication or legal submission rather than by changing the underlying record.

Finally, involve legal advisers early. This case shows that arguments based only on breadth may not succeed. A more useful early assessment usually asks: what is the statutory power, what is the connection between the requested documents and the review, what can be produced now, what cannot be produced, and what communication should be made before the deadline?

The Full Court judgment was delivered on 25 July 2025. It was an appeal from Yoong v Director, Professional Services Review [2023] FCA 1186. The appeal was heard on 20 August 2024 and was allowed. The Court set aside the relevant orders made below and dismissed the judicial review application.

The orders also dealt with costs. Subject to a short liberty to apply process, the respondent was ordered to pay the appellant's costs of the appeal and the proceeding below. The judgment sits within the Federal Court's administrative and constitutional law and human rights practice area, but its practical significance is strongest for Medicare-funded healthcare practice management.