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HEALTH INSURANCE ACT 1973 - SECT 124FF

Determinations in relation to pathology and diagnostic imaging offences and contraventions

             (1)  Subject to subsection 124J(8), where a Committee has determined, under subsection 124FE(1) or (2), that the Committee should consider whether a person caused or permitted a relevant offence or relevant civil contravention under Division 2 or 3 of Part IIBA to be engaged in by another person, the Committee must determine whether the person caused or permitted the offence or contravention to be engaged in by the other person.

             (2)  Where the Committee determines that a person caused or permitted another person to engage in a relevant offence or relevant civil contravention under Division 2 or 3 of Part IIBA, it must make one of the following determinations:

                     (a)  that no action should be taken against the person;

                     (b)  that it should counsel the person;

                     (c)  that it should reprimand the person;

                     (d)  where the person is a practitioner--that the person is disqualified;

                     (e)  where the person employs, or has employed, a practitioner--that any practitioner who is employed by the person is, while so employed, taken to be disqualified;

                      (f)  where the person is or has been an officer of a body corporate that employs, or has employed, a practitioner--that any practitioner who is employed by a body corporate of which the person is an officer is, while so employed at a time when the person is such an officer, taken to be disqualified.

             (3)  Where the Committee determines under paragraph (2)(d), (e) or (f) that a practitioner is disqualified, or is taken to be disqualified in certain circumstances, it must specify in the determination whether the practitioner is, or is taken to be, 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.

             (4)  Where the Committee determines under paragraph (2)(d), (e) or (f) that a practitioner is disqualified, or is taken to be disqualified in certain circumstances, the Committee must specify in the determination the period over which the disqualification is to have effect, being a period that ends within 5 years after the day on which the determination takes effect.

             (5)  Where the Committee determines that pathology services or diagnostic imaging services were rendered as a result of the offence or contravention being engaged in by a person, it must:

                     (a)  identify those services; and

                     (b)  if medicare benefit has been paid, or is payable, in respect of the rendering of services identified by the Committee--make one of the following determinations:

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

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

             (6)  Where:

                     (a)  the Committee determines that a person caused or permitted another person to engage in a relevant offence or relevant civil contravention under Division 2 or 3 of Part IIBA; and

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

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.

             (7)  In making a determination, the Committee must comply with guidelines in force under section 124H.

             (8)  A determination must be in writing.



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