Commonwealth Consolidated Acts

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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), (5) and (6), 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).

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 (whether by notice under section 129AAD or otherwise) 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 about the service; and

(b) before the CEO gives a notice to the person under section 129AAD that specifies 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 section 129AAD that specifies the service; and

(b) before the end of the period specified in the notice;

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 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)  A person's (the practitioner's ) base penalty amount for a professional service (the latest professional service ) rendered by, or on behalf of, the practitioner is increased by 50% if:

                     (a)  any of the following apply:

                              (i)  the Chief Executive Medicare (the CEO ) gives a notice to the practitioner under section 129AAD that specifies the latest professional service;

                             (ii)  the CEO serves a notice on the practitioner claiming an amount as a debt due to the Commonwealth under subsection 129AC(1) and that amount consists of, or includes, an amount in respect of the latest professional service;

                            (iii)  the CEO gives a notice to another person under section 129AAD that specifies the latest professional service; and

                     (b)  any of the following apply:

                              (i)  in the 24 months immediately before the notice is given or served, the CEO has given to the practitioner one or more other notices under section 129AAD specifying other professional services rendered by, or on behalf of, the practitioner;

                             (ii)  in the 24 months immediately before the notice is given or served, the CEO has served on the practitioner one or more other notices claiming an amount as a debt due to the Commonwealth under subsection 129AC(1) consisting of, or including, other professional services rendered by, or on behalf of, the practitioner;

                            (iii)  in the 24 months immediately before the notice is given or served, the CEO has given to another person one or more other notices under section 129AAD specifying other professional services that were rendered by, or on behalf of, the practitioner; and

                     (c)  the total of:

                              (i)  the sum of the recoverable amounts (see subsection (2)) in respect of each other professional service; and

                             (ii)  the sum of the base penalty amounts for each other professional service as reduced or increased in accordance with this section (if relevant);

                            is more than:

                            (iii)  $30,000; or

                            (iv)  if a higher amount is prescribed by the regulations--that higher amount.

             (6)  If both subsections (4) and (5) apply in relation to a professional service, apply subsection (4) and then subsection (5). In applying subsection (5) in that case, the base penalty amount is that amount as increased under subsection (4).

Interaction between reduction and increase

             (7)  If a base penalty amount is subject to both a reduction and an increase, apply the reduction first.



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