HEALTH INSURANCE ACT 1973 - SECT 19B Medicare benefit not payable in respect of services rendered by disqualified practitioners
HEALTH INSURANCE ACT 1973 - SECT 19B
Medicare benefit not payable in respect of services rendered by disqualified practitioners"partly disqualified" means disqualified (other than fully disqualified), or taken to be disqualified (other than fully disqualified), under an agreement that was in effect under section 92 or under a final determination under section 106TA or a determination under Part VB.
"practitioner" has the same meaning as in section 124B.
(2) A medicare benefit is not payable in respect of a professional service (including a pathology service) if:
(a) at the time when the service was rendered, the person who rendered the service, or the practitioner on whose behalf the service was rendered, was a practitioner:
(iaa) who was fully disqualified under an agreement that was in effect under section 92; or
(ia) who was fully disqualified under section 105; or
(ib) in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(h) that the practitioner be fully disqualified was in effect; or
(i) in relation to whom a determination under paragraph 124F(2)(e) or 124FF(2)(d) that the practitioner be fully disqualified was in effect; or
(ii) who was taken to be fully disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect; or
(b) at the time when the service was rendered, the person who rendered the service, or the practitioner on whose behalf the service was rendered, was a practitioner:
(ia) who was partly disqualified under an agreement that was in effect under section 92 in respect of that service; or
(ib) in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(g) that the practitioner be partly disqualified was in effect in respect of that service; or
(i) in relation to whom a determination under paragraph 124F(2)(d) or 124FF(2)(d) that the practitioner be partly disqualified was in effect in respect of that service; or
(ii) who was taken to be partly disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect in respect of that service; or
(c) the service was initiated by a person other than the person who rendered the service, and the person who initiated the service, or the practitioner on whose behalf the service was initiated, was a practitioner:
(ia) who was fully disqualified under an agreement that was in effect under section 92; or
(i) who was fully disqualified under section 105; or
(ii) in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(h) that the practitioner be fully disqualified was in effect; or
(iii) in relation to whom a determination under paragraph 124F(2)(e) or 124FF(2)(d) that the practitioner be fully disqualified was in effect; or
(iv) who was taken to be fully disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect; or
(d) the service was initiated by a person other than the person who rendered the service, and the person who initiated the service, or the practitioner on whose behalf the service was initiated, was a practitioner:
(i) who was partly disqualified under an agreement that was in effect under section 92 in respect of that service; or
(ii) in relation to whom a final determination under section 106TA containing a direction under paragraph 106U(1)(g) that the practitioner be partly disqualified was in effect in respect of that service; or
(iii) in relation to whom a determination under paragraph 124F(2)(d) or 124FF(2)(d) that the practitioner be partly disqualified was in effect in respect of that service; or
(iv) who was taken to be partly disqualified because a determination under paragraph 124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect in respect of that service.
(3) A medicare benefit is not payable in respect of a pathology
service if at the time when the service was rendered, the person by whom or on
whose behalf the service was rendered was a person in relation to whom a
determination of the kind referred to in subparagraph 124FB(1)(e)(vi)
was in effect in respect of that service.