HEALTH INSURANCE ACT 1973 - SECT 23DZZIL Provider civil penalty provisions--offering or providing prohibited benefits

HEALTH INSURANCE ACT 1973 - SECT 23DZZIL

Provider offers or provides a prohibited benefit

  (1)   A person contravenes this subsection if:

  (a)   the person is a provider of one or more kinds of pathology services or diagnostic imaging services; and

  (b)   the provider offers or provides a benefit to a second person; and

  (c)   the second person is, or is connected to, a requester of any of those kinds of services; and

  (d)   the benefit:

  (i)   would be reasonably likely to induce a requester to request any of those kinds of services from a provider; or

  (ii)   is related to the business of rendering pathology services or diagnostic imaging services, as the case requires; and

  (e)   the benefit is not a permitted benefit.

Civil penalty:

  (a)   for an individual--600 penalty units; and

  (b)   for a body corporate--6,000 penalty units.

Provider knows that a person connected to a provider offers or provides a prohibited benefit

  (2)   A person contravenes this subsection if:

  (a)   the person is a provider of one or more kinds of pathology services or diagnostic imaging services; and

  (b)   a second person offers or provides a benefit to a third person; and

  (c)   the second person is connected to the provider; and

  (d)   the third person is, or is connected to, a requester of any of those kinds of services; and

  (e)   the provider knows (either at the time of the offer or provision of the benefit or at any later time) that:

  (i)   the second person offers or provides the benefit to the third person; and

  (ii)   the second person is connected to the provider; and

  (iii)   the third person is, or is connected to, the requester; and

  (f)   the benefit:

  (i)   would be reasonably likely to induce a requester to request any of those kinds of services from a provider; or

  (ii)   is related to the business of rendering pathology services or diagnostic imaging services, as the case requires; and

  (g)   the benefit is not a permitted benefit.

Civil penalty:

  (a)   for an individual--600 penalty units; and

  (b)   for a body corporate--6,000 penalty units.

  (3)   Subsection   (2) does not apply if:

  (a)   within 30 days after the provider first becomes aware as mentioned in paragraph   (2)(e), the provider reports the benefit to the Chief Executive Medicare, in the form approved in writing by the Chief Executive Medicare; or

  (b)   that 30 day period has not elapsed.