MLR1PP11660 - Penalties guidance: the administrative action following a request for a Review continued

The submission is the only opportunity the Decision Maker will have to explain to the Review Officer why their decision is correct. The clearer the submission is the easier this will be.

The Review Officer will not normally discuss the case with the Decision Maker but may need to seek clarification of unclear issues.

Where the business provides further information the Review Officer will consider whether it is possible to incorporate it into the Review.

If the new information enables the Decision Maker to reach agreement with the business the Decision Maker should determine the review or vary or cancel the decision as appropriate and this should always be in liaison with the Review Officer so the Review can be closed and the User Interest and Appeals Indicators lifted. If agreement cannot be reached the Decision Maker must fully set out the effect the new information is considered to have on the Decision to allow the Review Officer to conclude the Review.

The Review Officer may conclude that the Decision should be:

• Upheld: the original Decision should stand;
• Varied: the original Decision should be changed in some way;
• Cancelled: the original Decision should be vacated.

The Review Officer will send a ‘Conclusion of Review Letter’ to the business and at the same time copy in the Decision Maker.

Remember if new information comes to the Decision Maker from the business before the review request has been sent to the Appeals Team, and it enables the Decision Maker to reach agreement with the business, then there is no need to send the penalty case for review.