HEALTH INSURANCE ACT 1973 - SECT 129AEB Amount of administrative penalty
HEALTH INSURANCE ACT 1973 - SECT 129AEB
Amount of administrative penalty(1) The amount of the administrative penalty in respect of a professional service is worked out in accordance with this section.
Base penalty amount
(2) Subject to subsections (3), (4) and (5), the amount (the base penalty amount ) of the administrative penalty is 20% of whichever of the following applies in respect of the professional service:
(a) the recoverable amount referred to in paragraph 129AEA(1)(b);
(b) the recoverable amount referred to in paragraph 129AEA(2)(e);
(c) the recoverable amount referred to in paragraph 129AEA(3)(e);
(d) the recoverable amount referred to in paragraph 129AEA(4)(a).
Reductions in base penalty amount
(3) A person's base penalty amount for a professional service is reduced in accordance with the table.
Reductions in base penalty amount | ||
Item | If ... | the base penalty amount is reduced by ... |
1 | before the Chief Executive Medicare (the CEO ) contacts the person under subsection 129AAD(2) or (3) about the professional service, the person voluntarily tells the CEO, or a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973 ), in the form approved in writing by the CEO, that an amount paid, purportedly by way of benefit or payment under this Act, in respect of the service exceeds the amount (if any) that should have been paid | 100% |
2 | (a) after the Chief Executive Medicare (the CEO ) contacts the person under subsection 129AAD(3) about the service; and (b) before the CEO gives a notice to the person under subsection 129AAD(2) that specifies the service; and (c) before the CEO gives notice to the person under subsection 129AAI(1) or 129ACA(3) of a decision to claim an amount as a debt in relation to the service; the person voluntarily tells the CEO, or a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973 ), in the form approved in writing by the CEO, that an amount paid, purportedly by way of benefit or payment under this Act, in respect of the service exceeds the amount (if any) that should have been paid | 50% |
3 | (a) after the Chief Executive Medicare (the CEO ) gives a notice to the person under subsection 129AAD(2) that specifies the service; and (b) before the end of the period specified in the notice; and (c) before the CEO gives notice to the person under subsection 129AAI(1) or 129ACA(3) of a decision to claim an amount as a debt in relation to the service; the person tells the CEO, or a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973 ), in the form approved in writing by the CEO, that an amount paid, purportedly by way of benefit or payment under this Act, in respect of the service exceeds the amount (if any) that should have been paid | 25% |
Increases in base penalty amount
(4) A person's base penalty amount for a professional service is increased by 25% if:
(a) the Chief Executive Medicare gives a notice to the person under section 129AAD or subsection 129ACA(7) that specifies the service; and
(b) the person does not comply with the notice in respect of the service, or any other professional service specified in the notice, within the period specified in the notice.
(5) If the administrative penalty is in respect of a professional service for which a determination has been made under subsection 129ACA(2):
(a) apply subsections (3) and (4) in relation to the primary debtor and not the secondary debtor; and
(b) apportion the base penalty amount calculated in accordance with paragraph (a) of this subsection between the primary debtor and secondary debtor in the same way as the recoverable amount in respect of the professional service was apportioned in accordance with the determination made under subsection 129ACA(2).
Interaction between reduction and increase
(7) If a base penalty amount is subject to both a reduction and
an increase, apply the reduction first.