HEALTH INSURANCE ACT 1973 - SECT 124FB Determinations in relation to breach of undertaking by approved pathology practitioner

HEALTH INSURANCE ACT 1973 - SECT 124FB

  (1)   Subject to subsection   124J(8), where:

  (a)   a Committee is established under subsection   124E(3) in relation to an approved pathology practitioner; or

  (b)   a Committee has made a determination, under subsection   124FA(2), that the Committee should consider whether an approved pathology practitioner has breached an undertaking;

the Committee shall:

  (c)   determine whether the practitioner has breached the undertaking given by the practitioner;

  (d)   if the Committee determines that the practitioner has breached the undertaking given by the practitioner by reason of having rendered excessive pathology services--identify those services; and

  (e)   if the Committee determines that the practitioner has breached the undertaking given by the practitioner--make one or more of the following determinations:

  (i)   that no action should be taken against the practitioner;

  (ii)   that it should counsel the practitioner;

  (iii)   that it should reprimand the practitioner;

  (iv)   that the undertaking given by the practitioner should be revoked;

  (v)   that no undertaking given by the practitioner should be accepted by the Minister under section   23DC during the period specified in the determination (being a period expiring not later than 5 years after the day on which the determination takes effect);

  (vi)   that medicare benefits should not be payable, during the period specified in the determination (being a period expiring not later than 5 years after the day on which the determination takes effect), in respect of pathology services, being pathology services of a kind specified in the determination, that are rendered by or on behalf of the practitioner;

  (vii)   where a medicare benefit is payable, but has not been paid, to the practitioner in respect of a pathology service and the Committee is of the opinion that the practitioner failed to comply with the undertaking in relation to that service--that the medicare benefit or a specified part of the medicare benefit cease to be payable;

  (viii)   where a medicare benefit has been paid to the practitioner, or has been paid, or is payable, to a person other than the practitioner, in respect of a pathology service and the Committee is of the opinion that the practitioner failed to comply with the undertaking in relation to that service--that the amount of the medicare benefit or a specified part of that amount be payable by the practitioner to the Commonwealth.

  (2)   In making a determination under subsection   (1) in relation to a practitioner, the Committee shall comply with guidelines in force under section   124H.

  (3)   A determination under subsection   (1) shall be made in writing.