HEALTH INSURANCE ACT 1973 - SECT 129AC Recovery of amounts overpaid etc. and administrative penalties

HEALTH INSURANCE ACT 1973 - SECT 129AC

False or misleading information

  (1)   Where, as a result of the giving of false or misleading information, an amount paid, purportedly by way of benefit or payment under this Act, exceeds the amount (if any) that should have been paid, the amount of the excess is recoverable as a debt due to the Commonwealth from the person by or on behalf of whom the information was given, or from the estate of that person, whether or not the amount was paid to that person, and whether or not any person has been convicted of an offence in relation to the giving of the information.

  (1AAA)   For the purposes of subsection   (1), it is immaterial whether the false or misleading information is given:

  (a)   in a document; or

  (b)   in a statement; or

  (c)   in any other form.

  (1AA)   Subsection   (1) does not apply to an amount if subsection   129ACA(1) applies to the amount.

Failure to produce document

  (1A)   Subject to subsection   (1B), if:

  (a)   a person referred to in paragraph   129AAD(2)(a) is required, by a notice given under section   129AAD, to produce a document, extract or copy in respect of a professional service; and

  (b)   the person does not comply with the requirement within the period set out in the notice;

the amount paid, purportedly by way of benefit or payment under this Act, in respect of the service, is recoverable as a debt due to the Commonwealth from the person, or the estate of the person, whether or not the amount was paid to the person.

  (1B)   Subsection   (1A) does not apply if the person concerned satisfies the Chief Executive Medicare that the person's non - compliance is due to circumstances beyond the person's control.

Note:   See section   129AAJ for review of decisions.

Amount not properly substantiated--notice to person referred to in paragraph   129AAD(2)(a)

  (1C)   Subject to subsection   (1D), if:

  (a)   a person referred to in paragraph   129AAD(2)(a) is required, by a notice given under section   129AAD, to produce a document, extract or copy in respect of a professional service; and

  (b)   the person complies with the requirement within the period set out in the notice; and

  (c)   the information contained in the document, extract or copy does not properly substantiate (wholly or partly) that the amount paid, purportedly by way of benefit or payment under this Act, in respect of the service, should have been paid;

then, to the extent that the amount is not properly substantiated, the amount is recoverable as a debt due to the Commonwealth from the person, or the estate of the person, whether or not the amount was paid to the person.

  (1D)   Subsection   (1C) does not apply if the person concerned satisfies the Chief Executive Medicare that the reason that the information contained in the document, extract or copy does not properly substantiate the amount is due to circumstances beyond the person's control.

Note:   See section   129AAJ for review of decisions.

Amount not properly substantiated--notice to person referred to in paragraph   129AAD(2)(b)

  (1E)   Subject to subsection   (1F), if:

  (a)   a person (the notice recipient ) referred to in paragraph   129AAD(2)(b) is required, by a notice given under section   129AAD, to produce a document, extract or copy in respect of a professional service; and

  (b)   the notice recipient complies with the requirement within the period set out in the notice; and

  (c)   the information contained in the document, extract or copy does not properly substantiate (wholly or partly) that the amount paid, purportedly by way of benefit or payment under this Act, in respect of the service, should have been paid;

then, to the extent that the amount is not properly substantiated, the amount is recoverable as a debt due to the Commonwealth from:

  (d)   the person who rendered the service, or on whose behalf the service was rendered; or

  (e)   the estate of that person;

whether or not the amount was paid to that person.

  (1F)   Subsection   (1E) does not apply if the person from whom the amount concerned is recoverable satisfies the Chief Executive Medicare that the reason that the information contained in the document, extract or copy does not properly substantiate the amount is due to circumstances beyond the control of the person and the notice recipient.

Note:   See section   129AAJ for review of decisions.

Administrative penalty

  (1G)   If:

  (a)   a person is given a notice under section   129AEC of the person's liability to pay an administrative penalty; and

  (b)   the person does not pay the penalty by the day set out in the notice as the day by which the penalty becomes due for payment;

the amount set out in the notice is recoverable as a debt due to the Commonwealth from the person or the estate of the person.

Recovery once only

  (1H)   To avoid doubt, an amount paid purportedly by way of benefit or payment under this Act is recoverable under this section once only.

Interest on amounts

  (2)   Where:

  (a)   an amount (in this subsection referred to as the principal sum ) is recoverable as a debt due to the Commonwealth from a person, or from an estate, under subsection   (1), (1A), (1C), (1E) or (1G); and

  (b)   the Chief Executive Medicare has served a notice on the person, or on the estate, as the case may be, claiming the amount as a debt due to the Commonwealth; and

  (c)   either of the following conditions are satisfied:

  (i)   an arrangement has been entered into between the Chief Executive Medicare and the person or the estate, as the case may be, within a period of 3 months following the service of the notice or such longer period as the Chief Executive Medicare allows (which period or longer period is in this section referred to as the relevant period ), being an arrangement for the repayment of the principal sum, and default has been made (whether before or after the end of the relevant period) in the payment of an amount as required by the arrangement; or

  (ii)   at the end of the relevant period, such an arrangement has not been entered into and all or part of the principal sum remains unpaid;

then, from the day after the end of the relevant period, interest at the prescribed rate becomes payable on so much of the principal sum as from time to time remains unpaid, and the interest so payable is recoverable as a debt due to the Commonwealth from the person, or from the estate, as the case may be.

  (3)   Notwithstanding subsection   (2), in any proceedings instituted by the Commonwealth for the recovery of an amount due under subsection   (2), the court may order that the interest payable under that subsection shall be, and shall be deemed to have been, so payable from a day later than the day referred to in that subsection.