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HEALTH INSURANCE ACT 1973 - SECT 124F

Determinations in relation to relevant offences and relevant civil contraventions

Determinations

             (1)  Subject to subsections 124J(8) and 124T(3), a Committee established under subsection 124E(1) in relation to a practitioner shall make a determination in relation to the practitioner in respect of the commission by the practitioner of any relevant offence or relevant civil contravention that is the subject of a notice under section 124D and has not been the subject of a previous determination by a Committee.

             (2)  A Committee established under subsection 124E(1) in relation to a practitioner shall, in making a determination in relation to the practitioner, determine that:

                     (a)  no action should be taken against the practitioner;

                     (b)  it should counsel the practitioner;

                     (c)  it should reprimand the practitioner;

                     (d)  the practitioner is disqualified in respect of one or more of the services mentioned in subsection (4A); or

                     (e)  the practitioner is fully disqualified; or

                      (f)  in relation to a practitioner who has engaged in a relevant offence or a relevant civil contravention under Division 2 or 3 of Part IIBA:

                              (i)  any other practitioner who is employed, or engaged under a contract for services, by the practitioner is taken to be disqualified while so employed or so engaged; or

                             (ii)  if the practitioner is an officer of a body corporate--any other practitioner who is employed, or engaged under a contract for services, by the body corporate is taken to be disqualified while so employed or so engaged and while the first-mentioned practitioner is an officer of the corporation.

             (3)  In making a determination under subsection (2) in relation to a practitioner, a Committee shall:

                     (a)  without limiting the generality of the matters to which it may have regard in making the determination, have regard to the nature of, and the circumstances concerning the commission of:

                              (i)  each relevant offence of which the practitioner has been convicted; and

                             (ii)  each offence of which the practitioner has been convicted before the commencement of this Part, being an offence that would have been a relevant offence if the conviction had occurred after that commencement; and

                            (iii)  each relevant civil contravention for which a pecuniary penalty order has been made against the practitioner; and

                     (b)  comply with guidelines in force under section 124H.

             (4)  A determination under subsection (2) shall be made in writing.

Disqualification

          (4A)  If a Committee determines under paragraph (2)(d) or (f) that a practitioner is, or is taken to be, disqualified, it must specify in the determination whether the practitioner is fully disqualified or disqualified in respect of one or more of the following:

                     (a)  the provision of specified professional services, or the provision of professional services other than specified professional services;

                     (b)  the provision of professional services to a specified class of persons, or the provision of professional services to persons other than a specified class of persons;

                     (c)  the provision of professional services within a specified location, or the provision of professional services otherwise than within a specified location.

Note:          For specification by class, see subsection 33(3AB) of the Acts Interpretation Act 1901 .

             (5)  Where a Committee determines under paragraph (2)(d) or (e) that a practitioner is disqualified, the Committee shall specify in the determination the period over which the disqualification is to have effect, being a period that ends:

                     (a)  where the determination is a review of a period of disqualification referred to in subsection 124D(3)--on or before the day on which that period of disqualification is to come to an end; or

                     (b)  in any other case--within 5 years after the day on which the determination comes into effect.

Medicare benefits

             (6)  If, in making a determination under subsection (2) in relation to a practitioner, a Committee:

                     (a)  is satisfied that the practitioner engaged in a relevant offence or a relevant civil contravention under Division 2 or 3 of Part IIBA; and

                     (b)  determines that pathology services or diagnostic images were rendered as a result of the relevant offence or relevant civil contravention;

the Committee must, in its determination:

                     (c)  identify the services; and

                     (d)  if medicare benefit has been paid, or is payable, in respect of the services--determine that:

                              (i)  if the medicare benefit is payable to the practitioner, but has not been paid--the medicare benefit or a specified part of it ceases to be payable; or

                             (ii)  if the medicare benefit has been paid to the practitioner, or has been paid or is payable to a person other than the practitioner--the medicare benefit or a specified part of it be payable by the practitioner to the Commonwealth.

Remote area exemptions

             (7)  If:

                     (a)  a person (the practitioner ) is a medical practitioner who has been granted a remote area exemption that is in force under section 23DX or 23DXA; and

                     (b)  a Committee determines that the practitioner engaged in a relevant offence or a relevant civil contravention under Division 2 or 3 of Part IIBA in relation to diagnostic imaging services;

the Committee must include in its determination under subsection (2) an advice to the Minister as to whether the remote area exemption should be revoked, and its reasons for so advising.



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