Commonwealth Consolidated Acts

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HEALTH INSURANCE ACT 1973 - SECT 82

Definitions of inappropriate practice

Unacceptable conduct

             (1)  A practitioner engages in inappropriate practice if the practitioner's conduct in connection with rendering or initiating services is such that a Committee could reasonably conclude that:

                     (a)  if the practitioner rendered or initiated the services as a general practitioner--the conduct would be unacceptable to the general body of general practitioners; or

                     (b)  if the practitioner rendered or initiated the services as a specialist (other than a consultant physician) in a particular specialty--the conduct would be unacceptable to the general body of specialists in that specialty; or

                     (c)  if the practitioner rendered or initiated the services as a consultant physician in a particular specialty--the conduct would be unacceptable to the general body of consultant physicians in that specialty; or

                     (d)  if the practitioner rendered or initiated the services as neither a general practitioner nor a specialist but as a member of a particular profession--the conduct would be unacceptable to the general body of the members of that profession.

Prescribed pattern of services

          (1A)  Subject to subsections (1B) and (1C), a practitioner engages in inappropriate practice in rendering or initiating services during a particular period (the relevant period ) if the circumstances in which some or all of the services were rendered or initiated constitute a prescribed pattern of services.

          (1B)  A practitioner does not, under subsection (1A), engage in inappropriate practice in rendering or initiating services on a particular day during the relevant period if a Committee could reasonably conclude that, on that day, exceptional circumstances existed that affected the rendering or initiating of the services.

          (1C)  Subsection (1B) does not affect the operation of subsection (1A) in respect of the remaining day or days during the relevant period on which the practitioner rendered or initiated services even if the circumstances in which the services were rendered or initiated on that day or those days would not, if considered alone, have constituted a prescribed pattern of services.

          (1D)  The circumstances that constitute exceptional circumstances for the purposes of subsection (1B) include, but are not limited to, circumstances that are prescribed by the regulations to be exceptional circumstances.

Causing or permitting inappropriate practice

             (2)  A person (including a practitioner) engages in inappropriate practice if the person:

                     (a)  knowingly, recklessly or negligently causes, or knowingly, recklessly or negligently permits, a practitioner employed by the person to engage in conduct that constitutes inappropriate practice by the practitioner under subsection (1) or (1A); or

                     (b)  is an officer of a body corporate and knowingly, recklessly or negligently causes, or knowingly, recklessly or negligently permits, a practitioner employed by the body corporate to engage in conduct that constitutes inappropriate practice by the practitioner under subsection (1) or (1A).

Matters to which Committee must have regard

             (3)  A Committee must, in determining whether a practitioner's conduct in connection with rendering or initiating services was inappropriate practice, have regard to (as well as to other relevant matters) whether or not the practitioner kept adequate and contemporaneous records of the rendering or initiation of the services.



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