SIRA's approach to regulation of health and related providers
SIRA’s regulatory approach is:
- customer-centric: protecting the interests of its customers (policy holders and people who make claims, now and in the future)
- intelligence-led: using the right data and insights to inform regulatory action
- risk-based: rating risks and issues to select the most appropriate regulatory response that is proportional to the risk.
Relevant health service providers
A relevant service provider is any person, organisation or body offering a service defined in Clause 4A of the State Insurance and Care Governance Regulation 2021, such as:
- medical practitioners
- allied health practitioners
- workplace rehabilitation providers
- medico-legal providers
- injury management consultants and independent consultants
- pharmaceutical services
- dentists
- providers of domestic assistance
- providers of aids, appliances or prostheses
- certain health-related administrative services.
SIRA's powers
The State Insurance Care and Governance Act 2015 (the SICG Act) gives SIRA the authority to:
- direct relevant service providers to provide information (under section 26C)
- direct relevant service providers to take specified action or provide/not provide specified relevant services (under section 26D)
- keep a register of providers given a 26D directive
- make regulations and issue guidelines.
Types of behaviour SIRA regulates
SIRA regulates non-compliance with:
- the Guidelines for the Provision of Relevant Services (Health and Related Services) (the Guidelines), and
- workers compensation and motor accidents legislation, regulations, and related guidelines.
Some examples of matters that SIRA may investigate include:
- reports that practitioners don’t comply with requirements in guidelines
- services delivered without required pre-approval
- billing charges exceeding SIRA’s maximum fees
- items not eligible to be billed for, such as non-specialists billing for specialist items
- service patterns significantly different to peers, considering the complexity or severity of injuries treated.
- SIRA primarily targets patterns of non-compliance rather than isolated incidents.
Types of behaviour SIRA does not regulate
Where clinical concerns arise about potential risk to the health or welfare of a person with an injury, SIRA may refer the matter to be investigated by a specialised body, such as the Health Care Complaints Commission or the Health Professional Councils Authority.
In general, SIRA will not investigate concerns about an RSP’s clinical or professional conduct, or interfere with individual clinical decisions.
Non-compliance
When addressing non-compliance, SIRA will consider a range of factors to ensure the actions taken are appropriate, proportionate and effective.
Providers are given the chance to explain their behaviour and argue why further compliance measures may not be necessary.
For detailed information, read SIRA's Supervision of Relevant Service Providers: Information for Providers.
Public register of providers given a direction
The register of providers given a direction under s26D of the SICG Act helps scheme users to make informed decisions about an RSP. The register will publish details including:
- the RSP’s name
- the RSP’s ABN, Australian Health Practitioner Regulation Agency registration number, or professional association registration number
- the RSP’s SIRA provider number (if applicable)
- the services provided by the RSP
- details about the direction given, including the start and any expiry date.
SIRA reserves the right to decide if publication of this information is appropriate on a case-by-case basis.
Updated 21 January 2025