Commonwealth of Australia Bills

[Index] [Search] [Download] [Related Items] [Help]


This is a Bill, not an Act. For current law, see the Acts databases.


HEALTH INSURANCE AMENDMENT (COMPLIANCE) BILL 2009

2008-2009
The Parliament of the
Commonwealth of Australia
HOUSE OF REPRESENTATIVES
Presented and read a first time
Health Insurance Amendment
(Compliance) Bill 2009
No. , 2009
(Health and Ageing)
A Bill for an Act to amend the Health Insurance Act
1973, and for related purposes
i Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
Contents
1 Short
title
...........................................................................................
1
2 Commencement
.................................................................................
1
3 Schedule(s)
........................................................................................
1
Schedule 1--Amendment of the Health Insurance Act 1973
3
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 1
A Bill for an Act to amend the Health Insurance Act
1
1973, and for related purposes
2
The Parliament of Australia enacts:
3
1 Short title
4
This Act may be cited as the Health Insurance Amendment
5
(Compliance) Act 2009.
6
2 Commencement
7
This Act commences on 1 January 2010.
8
3 Schedule(s)
9
Each Act that is specified in a Schedule to this Act is amended or
10
repealed as set out in the applicable items in the Schedule
11
2 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
concerned, and any other item in a Schedule to this Act has effect
1
according to its terms.
2
3
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 3
Schedule 1--Amendment of the Health
1
Insurance Act 1973
2
3
1 Subsection 3(1)
4
Insert:
5
medicare number has the same meaning as in subsection 84(1) of
6
the National Health Act 1953.
7
2 After section 129AAC
8
Insert:
9
129AAD Notice to produce documents
10
When section applies
11
(1) This section applies if the Medicare Australia CEO:
12
(a) has a reasonable concern that an amount paid, purportedly by
13
way of benefit or payment under this Act, in respect of one or
14
more professional services, may exceed the amount (if any)
15
that should have been paid; and
16
(b) has taken into account advice given to him or her by a
17
medical practitioner who is an employee of Medicare
18
Australia about the types of documents that contain
19
information relevant to ascertaining whether amounts paid in
20
respect of professional services of the same kind or kinds as
21
the service or services referred to in paragraph (a) should
22
have been paid.
23
Note:
For the purposes of paragraph (a), the CEO may, for example, have a
24
reasonable concern about benefits or payments made in respect of:
25
(a) professional services rendered by individual practitioners; or
26
(b) professional
services
rendered by particular kinds of
27
practitioners; or
28
(c) the rendering of services to which specific items, or groups of
29
items, relate.
30
CEO may require person to produce document etc.
31
(2) If the CEO believes on reasonable grounds that:
32
(a)
a
person:
33
Schedule 1 Amendment of the Health Insurance Act 1973
4 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
(i) who rendered a professional service in respect of which
1
an amount has been paid that is the subject of the CEO's
2
concern; or
3
(ii) on whose behalf such a professional service was
4
rendered; or
5
(b) subject to subsection (7), another person;
6
has possession, custody or control of one or more documents
7
relevant to ascertaining whether the amount paid in respect of the
8
professional service should have been paid, the CEO may, by
9
written notice given to the person, require the person to do any or
10
all of the things mentioned in subsection (5).
11
(3) The CEO may only give a notice to a person under subsection (2)
12
in respect of a professional service if the CEO has given the person
13
a reasonable opportunity to respond to a request (other than under
14
this section) to produce to the CEO, or an employee of Medicare
15
Australia, documents relevant to ascertaining whether the amount
16
paid, purportedly by way of benefit or payment under this Act, in
17
respect of the service, should have been paid.
18
(4) A notice may only be given in respect of a professional service that
19
was rendered in the period of 2 years immediately before the notice
20
is given.
21
(5) The CEO may require the person, in relation to each professional
22
service specified in the notice:
23
(a) subject to subsection (6), to produce to the CEO, or an
24
employee of Medicare Australia, any document, or extract of
25
any document, that is relevant for the purpose set out in
26
subsection (2); or
27
(b) to make a copy of any such document or extract and to
28
produce that copy to the CEO or employee.
29
Note:
For a person referred to in paragraph (2)(a), failure to comply with a
30
notice may lead to recovery action (see section 129AC) and an
31
administrative penalty may be applied (see sections 129AEA,
32
129AEB and 129AEC). For a person referred to in paragraph (2)(b),
33
failure to comply with a notice may lead to a civil penalty (see
34
section 129AAE).
35
(6) If a document, extract or copy contains clinical details relating to
36
an individual, the person to whom the notice is given is not
37
required to produce the document, extract or copy to a person other
38
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 5
than an employee of Medicare Australia who is a medical
1
practitioner.
2
CEO not to give notice to certain persons
3
(7) A person referred to in paragraph (2)(b) does not include:
4
(a) the person in respect of whom the professional service was
5
rendered; or
6
(b) the person who incurred the medical expenses in respect of
7
the service.
8
Content of notice
9
(8) The notice must:
10
(a) specify details of each professional service (including the
11
item, date on which the service was rendered and medicare
12
number of the person in respect of whom the service was
13
rendered) in relation to which the document, extract or copy
14
is to be produced; and
15
(b) specify the reason or reasons for the CEO's concern that an
16
amount paid, purportedly by way of benefit or payment under
17
this Act, in respect of each such service may exceed the
18
amount (if any) that should have been paid; and
19
(c) specify how the document, extract or copy is to be produced;
20
and
21
(d) contain a statement to the effect that the person to whom the
22
notice is given is not expected to produce a document, extract
23
or copy containing clinical details relating to an individual
24
unless the document, extract or copy is necessary to
25
ascertaining whether the amount paid in respect of the service
26
should have been paid; and
27
(e) specify the period within which, and place at which, the
28
document, extract or copy is to be produced.
29
The period specified under paragraph (e) must be a period ending
30
at least 21 days after the day on which the notice is given.
31
Health information
32
(9) The power under this section to require a document, extract or
33
copy to be produced includes the power to require the production
34
of a document, extract or copy containing health information
35
(within the meaning of the Privacy Act 1988) about an individual.
36
Schedule 1 Amendment of the Health Insurance Act 1973
6 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
Section not limited
1
(10) This section is not limited by:
2
(a) any other provision of this Act; or
3
(b) any provision of the Medicare Australia Act 1973 or any
4
other Act;
5
that relates to the powers of the CEO to require the production of
6
documents.
7
129AAE Civil penalty--failure to comply with requirement in notice
8
(1) A person referred to in paragraph 129AAD(2)(b) contravenes this
9
section if:
10
(a) the person is given a notice under section 129AAD requiring
11
the person to do something in respect of a professional
12
service; and
13
(b) the person fails to comply with the requirement within the
14
period specified in the notice.
15
Civil penalty:
16
(a) for an individual--20 penalty units; and
17
(b) for a body corporate--100 penalty units.
18
(2) It is a defence in proceedings for a contravention of subsection (1)
19
if:
20
(a) the failure to comply is brought about by another person over
21
whom the person has no control or by a non-human act or
22
event over which the person has no control; and
23
(b) the person could not reasonably be expected to guard against
24
the failure.
25
Note:
The defendant bears the onus of proving the matters necessary to
26
establish the defence.
27
129AAF Self-incrimination etc.
28
(1) A person is not excused from producing a document, extract or
29
copy when required to do so under section 129AAD on the ground
30
that doing so would tend to incriminate the person or expose the
31
person to a penalty.
32
(2) However, the production of the document, extract or copy, and any
33
information obtained as a direct or indirect result of the production
34
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 7
of the document, extract or copy, are not admissible in evidence
1
against the person in:
2
(a) any criminal proceedings, other than:
3
(i) proceedings for an offence against this Act dealing with
4
false or misleading information or documents; and
5
(ii) proceedings for an offence against section 137.1 or
6
137.2 of the Criminal Code (which deals with false or
7
misleading information or documents) that relates to
8
this Act; or
9
(b) any civil proceedings, other than a civil proceeding arising
10
under Part VIA or this Part.
11
129AAG CEO or employee of Medicare Australia may deal with
12
documents etc. produced
13
(1) If a document, extract or copy has been produced under
14
section 129AAD in respect of a professional service, the Medicare
15
Australia CEO, or an employee of Medicare Australia, may do all
16
or any of the things mentioned in subsection (2) for the purpose of
17
ascertaining whether the information contained in the document,
18
extract or copy properly substantiates that an amount paid,
19
purportedly by way of benefit or payment under this Act, in respect
20
of the service, should have been paid.
21
Note:
If the information does not properly substantiate the amount, recovery
22
action may be taken (see section 129AC) and an administrative
23
penalty may be applied (see sections 129AEA, 129AEB and
24
129AEC).
25
(2) The CEO or employee may:
26
(a) inspect the document, extract or copy; and
27
(b) make a copy of, or take an extract from, the document,
28
extract or copy; and
29
(c) retain the document, extract or copy in his or her possession
30
for such reasonable period as he or she thinks fit.
31
(3) The person otherwise entitled to possession of the document or
32
extract is entitled to be supplied, as soon as practicable, with a
33
copy certified by the CEO, or an employee, to be a true copy.
34
(4) The certified copy must be received in all courts and tribunals as
35
evidence as if it were the original.
36
Schedule 1 Amendment of the Health Insurance Act 1973
8 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
(5) Until a certified copy is supplied, the CEO, or an employee, must,
1
at such times and places as he or she thinks appropriate, permit the
2
person otherwise entitled to possession of the document or extract,
3
or a person authorised by that person, to inspect and make copies
4
of, or take extracts from, the document or extract.
5
(6) This section is not limited by:
6
(a) any other provision of this Act; or
7
(b) any provision of the Medicare Australia Act 1973 or any
8
other Act;
9
that relates to the powers of the CEO, or an employee of Medicare
10
Australia, to deal with a document, extract or copy as described in
11
subsection (2) of this section.
12
(7) An employee of Medicare Australia referred to in this section may
13
be an employee other than the employee to whom the document,
14
extract or copy was required to be produced.
15
129AAH Notice of decision: no amount recoverable because
16
amounts paid substantiated etc.
17
Amount paid substantiated
18
(1)
If:
19
(a) a person produces to the Medicare Australia CEO, or to an
20
employee of Medicare Australia, a document, extract or copy
21
relating to a professional service after being requested, or
22
required under section 129AAD, to do so; and
23
(b) the CEO decides that the information contained in the
24
document, extract or copy properly substantiates that the
25
amount paid, by way of benefit or payment under this Act, in
26
respect of the service, should have been paid;
27
the CEO must give the person written notice of the decision.
28
Circumstances beyond control exist
29
(2) If the CEO is satisfied, for the purposes of subsection 129AC(1B)
30
or (1D), that circumstances beyond a person's control exist, the
31
CEO must give the person written notice of the decision.
32
(3) If the CEO is satisfied, for the purposes of subsection 129AC(1F),
33
that circumstances exist beyond the control of:
34
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 9
(a) the person from whom the amount concerned is recoverable;
1
and
2
(b) the recipient of the notice concerned;
3
the CEO must give written notice of the decision to the person
4
from whom the amount concerned is recoverable.
5
Notice may include notice of other decisions
6
(4) The CEO's written notice to a person of a decision may include
7
written notice of other decisions referred to in this section, or
8
section 129AAI, that also are required to be given to the person.
9
129AAI Notice of decision: amounts recoverable
10
(1) If an amount is recoverable under subsection 129AC(1), (1A), (1C)
11
or (1E) as a debt due to the Commonwealth from a person, or from
12
an estate, the Medicare Australia CEO must give written notice to
13
the person or estate of:
14
(a) the decision to claim the amount as a debt; and
15
(b) the reasons for the decision; and
16
(c) the right of the person or estate to seek review of the decision
17
under subsection 129AAJ(1).
18
(2) The CEO's written notice to a person or an estate of a decision
19
may include written notice of other decisions referred to in this
20
section, or section 129AAH, that also are required to be given to
21
the person or estate. The written notice may also, as appropriate,
22
state that the CEO was not satisfied, for the purposes of subsection
23
129AC(1B), (1D) or (1F), that circumstances beyond a person's
24
control existed.
25
(3) A failure to comply with the requirements of subsection (1) does
26
not affect the validity of the decision.
27
(4) The CEO must not serve a notice on a person or an estate claiming
28
an amount as a debt before the end of the period of 28 days after
29
written notice of the decision referred to in subsection (1) is given
30
to the person or estate.
31
Schedule 1 Amendment of the Health Insurance Act 1973
10 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
129AAJ Review of decisions to claim amounts as debts
1
(1) If the Medicare Australia CEO makes a decision referred to in
2
subsection 129AAI(1) about a person or an estate, the person or
3
estate may apply in writing to the CEO, in the form approved in
4
writing by the CEO, for a review of the decision.
5
(2) An application for review of a decision must be made within 28
6
days after the person or estate is notified of the decision.
7
(3) On receiving an application for review of a decision, the CEO
8
must:
9
(a) review the decision; and
10
(b) confirm, vary or revoke the decision.
11
(4) The CEO must give to the applicant written notice of the decision
12
on the review within 28 days after receiving the application for
13
review.
14
(5) A failure to comply with subsection (4) does not affect the validity
15
of the CEO's decision on the review.
16
(6) To avoid doubt, a decision referred to in subsection 129AAI(1)
17
(including such a decision varied under this section) may be
18
reviewed under this section once only.
19
3 Application
20
Sections 129AAD, 129AAH and 129AAI of the Health Insurance Act
21
1973 apply in respect of a professional service that is rendered on or
22
after the commencement of those sections.
23
4 After subsection 129AC(1)
24
Insert:
25
Failure to produce document
26
(1A) Subject to subsection (1B), if:
27
(a) a person referred to in paragraph 129AAD(2)(a) is required,
28
by a notice given under section 129AAD, to produce a
29
document, extract or copy in respect of a professional
30
service; and
31
(b) the person does not comply with the requirement within the
32
period set out in the notice;
33
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 11
the amount paid, purportedly by way of benefit or payment under
1
this Act, in respect of the service, is recoverable as a debt due to
2
the Commonwealth from the person, or the estate of the person,
3
whether or not the amount was paid to the person.
4
(1B) Subsection (1A) does not apply if the person concerned satisfies
5
the Medicare Australia CEO that the person's non-compliance is
6
due to circumstances beyond the person's control.
7
Note:
See section 129AAJ for review of decisions.
8
Amount not properly substantiated--notice to person referred to in
9
paragraph 129AAD(2)(a)
10
(1C) Subject to subsection (1D), if:
11
(a) a person referred to in paragraph 129AAD(2)(a) is required,
12
by a notice given under section 129AAD, to produce a
13
document, extract or copy in respect of a professional
14
service; and
15
(b) the person complies with the requirement within the period
16
set out in the notice; and
17
(c) the information contained in the document, extract or copy
18
does not properly substantiate (wholly or partly) that the
19
amount paid, purportedly by way of benefit or payment under
20
this Act, in respect of the service, should have been paid;
21
then, to the extent that the amount is not properly substantiated, the
22
amount is recoverable as a debt due to the Commonwealth from
23
the person, or the estate of the person, whether or not the amount
24
was paid to the person.
25
(1D) Subsection (1C) does not apply if the person concerned satisfies
26
the Medicare Australia CEO that the reason that the information
27
contained in the document, extract or copy does not properly
28
substantiate the amount is due to circumstances beyond the
29
person's control.
30
Note:
See section 129AAJ for review of decisions.
31
Amount not properly substantiated--notice to person referred to in
32
paragraph 129AAD(2)(b)
33
(1E) Subject to subsection (1F), if:
34
(a) a person (the notice recipient) referred to in paragraph
35
129AAD(2)(b) is required, by a notice given under
36
Schedule 1 Amendment of the Health Insurance Act 1973
12 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
section 129AAD, to produce a document, extract or copy in
1
respect of a professional service; and
2
(b) the notice recipient complies with the requirement within the
3
period set out in the notice; and
4
(c) the information contained in the document, extract or copy
5
does not properly substantiate (wholly or partly) that the
6
amount paid, purportedly by way of benefit or payment under
7
this Act, in respect of the service, should have been paid;
8
then, to the extent that the amount is not properly substantiated, the
9
amount is recoverable as a debt due to the Commonwealth from:
10
(d) the person who rendered the service, or on whose behalf the
11
service was rendered; or
12
(e) the estate of that person;
13
whether or not the amount was paid to that person.
14
(1F) Subsection (1E) does not apply if the person from whom the
15
amount concerned is recoverable satisfies the Medicare Australia
16
CEO that the reason that the information contained in the
17
document, extract or copy does not properly substantiate the
18
amount is due to circumstances beyond the control of the person
19
and the notice recipient.
20
Note:
See section 129AAJ for review of decisions.
21
Administrative penalty
22
(1G)
If:
23
(a) a person is given a notice under section 129AEC of the
24
person's liability to pay an administrative penalty; and
25
(b) the person does not pay the penalty by the day set out in the
26
notice as the day by which the penalty becomes due for
27
payment;
28
the amount set out in the notice is recoverable as a debt due to the
29
Commonwealth from the person or the estate of the person.
30
Recovery once only
31
(1H) To avoid doubt, an amount paid purportedly by way of benefit or
32
payment under this Act is recoverable under this section once only.
33
Note 1: The heading to section 129AC is replaced by the heading "Recovery of amounts
34
overpaid etc. and administrative penalties".
35
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 13
Note 2: The following heading to subsection 129AC(1) is inserted "False or misleading
1
statements".
2
5 At the end of paragraph 129AC(2)(a)
3
Add ", (1A), (1C), (1E) or (1G)".
4
Note:
The following heading to subsection 129AC(2) is inserted "Interest on amounts".
5
6 At the end of paragraph 129AC(2)(a)
6
Add "and".
7
7 Subsection 129AC(4)
8
Repeal the subsection, substitute:
9
Set-off
10
(4) Despite any other provision of this Act, if:
11
(a) an amount (the recoverable amount) is recoverable from a
12
person under subsection (1), (1A), (1C), (1E) or (1G); and
13
(b) an amount (the later amount) of benefit or payment later
14
becomes payable to the person under this Act; and
15
(c) the person so agrees;
16
the Medicare Australia CEO may, on behalf of the
17
Commonwealth, set off all or a part of the recoverable amount
18
against all or a part of the later amount.
19
8 Application and saving
20
(1)
Subsection 129AC(4) of the Health Insurance Act 1973 as amended by
21
this Act applies in relation to amounts recoverable under subsection
22
129AC(1) of that Act before, on or after the commencement of this
23
item.
24
(2)
If a person's agreement referred to in subsection 129AC(4) of the
25
Health Insurance Act 1973 is in force, in relation to an amount,
26
immediately before the commencement of this item, that agreement is
27
taken to be in force for the purposes of:
28
(a) that amount; and
29
(b) that subsection as in force immediately after that
30
commencement.
31
(3)
Subitem (2) does not prevent the person withdrawing the agreement.
32
Schedule 1 Amendment of the Health Insurance Act 1973
14 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
9 After section 129AE
1
Insert:
2
129AEA Liability for administrative penalty
3
Subsection 129AC(1) applies
4
(1) A person is liable for an administrative penalty in respect of a
5
professional service rendered by, or on behalf of, the person if:
6
(a) the Medicare Australia CEO has served a notice on the
7
person claiming an amount (the total amount) as a debt due
8
to the Commonwealth under subsection 129AC(1); and
9
(b) the total amount consists of, or includes, an amount (the
10
recoverable amount) in respect of the service; and
11
(c) no part of the total amount became due more than 2 years
12
before the notice was served; and
13
(d) the total amount is more than:
14
(i)
$2,500;
or
15
(ii) if a higher amount is prescribed by the regulations--that
16
higher amount.
17
Subsection 129AC(1A) or (1C) applies
18
(2) A person is liable for an administrative penalty in respect of a
19
particular professional service if:
20
(a) a notice was given to the person under section 129AAD
21
requiring the person to produce a document, extract or copy
22
relevant to the particular professional service; and
23
(b) subsection 129AC(1A) or (1C) applies in respect of the
24
person and the particular professional service; and
25
(c) if the notice specifies one or more other professional
26
services--either or both of subsections 129AC(1A) and (1C)
27
apply in respect of the person and any other professional
28
service specified in the notice; and
29
(d) the sum of the amounts that may be recovered from the
30
person under those subsections in respect of the particular
31
professional service, and any other professional service
32
specified in the notice, is more than:
33
(i)
$2,500;
or
34
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 15
(ii) if a higher amount is prescribed by the regulations--that
1
higher amount; and
2
(e) the Medicare Australia CEO has served a notice on the
3
person claiming as a debt due to the Commonwealth the
4
amount (the recoverable amount) that may be recovered
5
from the person under whichever of subsection 129AC(1A)
6
or (1C) applies in respect of the person and the particular
7
professional service.
8
Subsection 129AC(1E) applies
9
(3) A person (the practitioner) who rendered a particular professional
10
service, or on whose behalf a particular professional service was
11
rendered, is liable for an administrative penalty in respect of the
12
service if:
13
(a) a notice was given to another person under section 129AAD
14
requiring the person to produce a document, extract or copy
15
relevant to the particular professional service; and
16
(b) subsection 129AC(1E) applies in respect of the practitioner
17
and the particular professional service; and
18
(c) if the notice specifies one or more other professional
19
services--subsection 129AC(1E) applies in respect of the
20
practitioner and any other professional service specified in
21
the notice; and
22
(d) the sum of the amounts that may be recovered from the
23
practitioner under that subsection in respect of the particular
24
professional service, and any other professional service
25
specified in the notice, is more than:
26
(i)
$2,500;
or
27
(ii) if a higher amount is prescribed by the regulations--that
28
higher amount; and
29
(e) the Medicare Australia CEO has served a notice on the
30
practitioner claiming as a debt due to the Commonwealth the
31
amount (the recoverable amount) that may be recovered
32
from the practitioner under subsection 129AC(1E) in respect
33
of the particular professional service.
34
129AEB Amount of administrative penalty
35
(1) The amount of the administrative penalty in respect of a
36
professional service is worked out in accordance with this section.
37
Schedule 1 Amendment of the Health Insurance Act 1973
16 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
Base penalty amount
1
(2) Subject to subsections (3), (4), (5) and (6), the amount (the base
2
penalty amount) of the administrative penalty is 20% of whichever
3
of the following applies in respect of the professional service:
4
(a) the recoverable amount referred to in paragraph
5
129AEA(1)(b);
6
(b) the recoverable amount referred to in paragraph
7
129AEA(2)(e);
8
(c) the recoverable amount referred to in paragraph
9
129AEA(3)(e).
10
Reductions in base penalty amount
11
(3) A person's base penalty amount for a professional service is
12
reduced in accordance with the table.
13
Reductions in base penalty amount
Item
If ...
the base penalty
amount is reduced
by ...
1
before the Medicare Australia CEO contacts the
person (whether by notice under section 129AAD
or otherwise) about the professional service, the
person voluntarily tells the CEO, or an employee
of Medicare Australia, in the form approved in
writing by the CEO, that an amount paid,
purportedly by way of benefit or payment under
this Act, in respect of the service exceeds the
amount (if any) that should have been paid
100%
2
(a) after the Medicare Australia CEO contacts the
person about the service; and
(b) before the CEO gives a notice to the person
under section 129AAD that specifies the
service;
the person voluntarily tells the CEO, or an
employee of Medicare Australia, in the form
approved in writing by the CEO, that an amount
paid, purportedly by way of benefit or payment
under this Act, in respect of the service exceeds the
amount (if any) that should have been paid
50%
3
(a) after the Medicare Australia CEO gives a notice
to the person under section 129AAD that
25%
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 17
Reductions in base penalty amount
Item
If ...
the base penalty
amount is reduced
by ...
specifies the service; and
(b) before the end of the period specified in the
notice;
the person tells the CEO, or an employee of
Medicare Australia, in the form approved in
writing by the CEO, that an amount paid,
purportedly by way of benefit or payment under
this Act, in respect of the service exceeds the
amount (if any) that should have been paid
Increases in base penalty amount
1
(4) A person's base penalty amount for a professional service is
2
increased by 25% if:
3
(a) the Medicare Australia CEO gives a notice to the person
4
under section 129AAD that specifies the service; and
5
(b) the person does not comply with the notice in respect of the
6
service, or any other professional service specified in the
7
notice, within the period specified in the notice.
8
(5) A person's (the practitioner's) base penalty amount for a
9
professional service (the latest professional service) rendered by,
10
or on behalf of, the practitioner is increased by 50% if:
11
(a) any of the following apply:
12
(i) the Medicare Australia CEO gives a notice to the
13
practitioner under section 129AAD that specifies the
14
latest professional service;
15
(ii) the CEO serves a notice on the practitioner claiming an
16
amount as a debt due to the Commonwealth under
17
subsection 129AC(1) and that amount consists of, or
18
includes, an amount in respect of the latest professional
19
service;
20
(iii) the CEO gives a notice to another person under
21
section 129AAD that specifies the latest professional
22
service; and
23
(b) any of the following apply:
24
Schedule 1 Amendment of the Health Insurance Act 1973
18 Health Insurance Amendment (Compliance) Bill 2009 No. , 2009
(i) in the 24 months immediately before the notice is given
1
or served, the CEO has given to the practitioner one or
2
more other notices under section 129AAD specifying
3
other professional services rendered by, or on behalf of,
4
the practitioner;
5
(ii) in the 24 months immediately before the notice is given
6
or served, the CEO has served on the practitioner one or
7
more other notices claiming an amount as a debt due to
8
the Commonwealth under subsection 129AC(1)
9
consisting of, or including, other professional services
10
rendered by, or on behalf of, the practitioner;
11
(iii) in the 24 months immediately before the notice is given
12
or served, the CEO has given to another person one or
13
more other notices under section 129AAD specifying
14
other professional services that were rendered by, or on
15
behalf of, the practitioner; and
16
(c) the total of:
17
(i) the sum of the recoverable amounts (see subsection (2))
18
in respect of each other professional service; and
19
(ii) the sum of the base penalty amounts for each other
20
professional service as reduced or increased in
21
accordance with this section (if relevant);
22
is more than:
23
(iii)
$30,000;
or
24
(iv) if a higher amount is prescribed by the regulations--that
25
higher amount.
26
(6) If both subsections (4) and (5) apply in relation to a professional
27
service, apply subsection (4) and then subsection (5). In applying
28
subsection (5) in that case, the base penalty amount is that amount
29
as increased under subsection (4).
30
Interaction between reduction and increase
31
(7) If a base penalty amount is subject to both a reduction and an
32
increase, apply the reduction first.
33
129AEC Notice of administrative penalty
34
The Medicare Australia CEO must give to a person who is liable
35
for an administrative penalty written notice of the following:
36
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2009 No. , 2009 19
(a) the person's liability to pay an administrative penalty in
1
respect of one or more professional services;
2
(b) the professional service to which each administrative penalty
3
relates;
4
(c) if there is more than one professional service--the total of
5
the administrative penalties;
6
(d) the day by which the penalty becomes due for payment
7
(which must be at least 14 days after the day on which the
8
notice is given);
9
(e) the fact that the notice is given under this section.
10
The notice may also deal with a debt due to the Commonwealth
11
under section 129AC arising in relation to the professional service.
12
10 Application
13
Sections 129AEA, 129AEB and 129AEC of the Health Insurance Act
14
1973 apply in respect of a professional service that is rendered on or
15
after the commencement of those sections.
16

 


[Index] [Search] [Download] [Related Items] [Help]