HEALTH INSURANCE ACT 1973 - SECT 106U Content of draft and final determinations
HEALTH INSURANCE ACT 1973 - SECT 106U
Content of draft and final determinations(1) A draft determination or a final determination must contain one or more of the following directions:
(a) that the Director, or the Director's nominee, reprimand the person under review;
(b) that the Director, or the Director's nominee, counsel the person under review;
(c) that any medicare benefit or dental benefit that would otherwise be payable for a service in the provision of which the person is stated in a report under section 106L to have engaged in inappropriate practice cease to be payable;
(ca) if any medicare benefit or dental benefit for a service:
(i) that was rendered or initiated by the person under review or an associated person; and
(ii) in connection with the rendering or initiation of which the person under review or an associated person is stated in a report under section 106L (other than a report based on a finding made under subsection 106K(2) or 106KB(3)) to have engaged in inappropriate practice;
has been paid (whether or not to the person under review)--that the person under review repay to the Commonwealth the whole or a part of the medicare benefit or dental benefit that was paid for that service;
(cb) if any medicare benefits or dental benefits for a class of services:
(i) that were rendered or initiated by the person under review or an associated person; and
(ii) in connection with the rendering or initiation of which, or of a proportion of which, the person under review or an associated person is stated in a report under section 106L, based on a finding made under subsection 106K(2), to have engaged in inappropriate practice;
have been paid (whether or not to the person under review)--that the person under review repay to the Commonwealth the whole or a part of the medicare benefits or dental benefits that were paid for the services or that proportion of the services, as the case may be;
(d) that any amount for treatment under a relevant DVA law that would otherwise be payable for a service in the provision of which the person is stated in a report under section 106L to have engaged in inappropriate practice ceases to be payable;
(da) if an amount has been paid (whether or not to the person under review) for treatment under a relevant DVA law relating to a service:
(i) that was rendered or initiated by the person under review or an associated person; and
(ii) in connection with the rendering or initiation of which the person under review or an associated person is stated in a report under section 106L (other than a report based on a finding made under subsection 106K(2) or 106KB(3)) to have engaged in inappropriate practice;
that the person under review repay to the Commonwealth the whole or a part of the amount paid for that service;
(ea) if the person under review is a midwife and there is in force in respect of the person an undertaking under section 21B--that the Minister's acceptance of the undertaking is to be taken to be revoked;
(eb) if the person under review is a nurse practitioner and there is in force in respect of the person an undertaking under section 22A--that the Minister's acceptance of the undertaking is to be taken to be revoked;
(f) if the person under review is a person in respect of whom a Part VII authority is in force and the service in connection with which the person is stated in a report under section 106L to have engaged in inappropriate practice involves prescribing or supplying a pharmaceutical benefit--that the Part VII authority be taken, for the purposes of the National Health Act 1953 , to be suspended;
(g) if the person under review is a practitioner--that the practitioner be disqualified, for a specified period starting when the determination takes effect, in respect of one or more of the following:
(i) provision of specified services, or provision of services other than specified services;
(ii) provision of services to a specified class of persons, or provision of services to persons other than persons included in a specified class of persons;
(iii) provision of services within a specified location, or provision of services otherwise than in a specified location;
(h) if the person under review is a practitioner--that the practitioner be fully disqualified for a specified period starting when the determination takes effect.
Note: Medicare benefits and dental benefits are not payable in respect of services rendered or initiated by, or on behalf of, disqualified practitioners (see section 19B of this Act in relation to medicare benefits, and section 20A of the Dental Benefits Act 2008 in relation to dental benefits).
(1A) For the purposes of paragraph (1)(cb), it is to be assumed that all the medicare benefits paid for services in the class of services referred to in that paragraph were paid at the lowest rate that was payable for any of the services included in the class.
(2A) A direction under paragraph (1)(f) must specify a period of suspension of up to 3 years, to start when the determination takes effect.
(3) For the purposes of paragraphs (1)(g) and (h), the period specified must not be more than:
(a) if the person under review is a practitioner in relation to whom an agreement under section 92, or a final determination under section 106TA, has previously taken effect--5 years; or
(b) in any other case--3 years.
(4) This section applies as if a reference in this section to a practitioner included a reference to a person who has been a practitioner.
"associated person" , in relation to a person under review, means:
(a) an employee of the person under review; or
(b) a person otherwise engaged by the person under review; or
(c) an employee of a body corporate of which the person under review is an officer; or
(d) a person otherwise engaged by a body corporate of which the person under review is an officer.
"Part VII authority" means any of the following authorities or approvals under Part VII of the National Health Act 1953 :
(a) the authority conferred upon a medical practitioner by section 88 of that Act;
(b) the approval of a dental practitioner as a participating dental practitioner under section 84A of that Act;
(ba) the approval of an optometrist as an authorised optometrist under section 84AAB of that Act;
(bb) the approval of an eligible midwife as an authorised midwife under section 84AAF of that Act;
(bc) the approval of an eligible nurse practitioner as an authorised nurse practitioner under section 84AAJ of that Act;
(c) the approval of a medical practitioner under section 92 of that Act;
(d) the authority conferred upon a medical practitioner by
section 93 of that Act to supply pharmaceutical benefits.