HEALTH INSURANCE ACT 1973 - SECT 92 Agreement entered into between Director and person under review
HEALTH INSURANCE ACT 1973 - SECT 92
Agreement entered into between Director and person under review(1) A person under review and the Director may enter into a written agreement under which:
(a) the person under review acknowledges that the person engaged in inappropriate practice in connection with the provision of specified services during the review period (whether rendered or initiated by the person or an associated person); and
(b) specified action in relation to the person under review (being action of a kind mentioned in subsection (2)) is to take effect.
Note: The effect of paragraph (b) and subsection (2) is that action may be specified in the agreement only in relation to the person under review, even if the inappropriate practice is in connection with the rendering or initiating of services by an associated person of the person under review.
(2) The action that may be specified under paragraph (1)(b) in the agreement includes any one or more of the following:
(a) that the Director, or the Director's nominee, is to reprimand the person under review;
(aa) that the Director, or the Director's nominee, is to counsel the person under review;
(b) if any medicare benefit or dental benefit has been paid (whether or not to the person under review) for services referred to in paragraph (1)(a)--that the person under review is to repay to the Commonwealth an amount equal to the whole or a specified part of that medicare benefit or dental benefit;
(c) that any medicare benefit or dental benefit that would otherwise be payable for services referred to in paragraph (1)(a) is to cease to be payable;
(ca) if an amount has been paid (whether or not to the person under review) for treatment under a relevant DVA law relating to services referred to in paragraph (1)(a)--that the person under review is to repay to the Commonwealth an amount equal to the whole or a specified part of the amount paid for the treatment;
(cb) that any amount for treatment under a relevant DVA law that would otherwise be payable for services referred to in paragraph (1)(a) is to cease to be payable;
(d) if any of the services referred to in paragraph (1)(a) were rendered or initiated by an associated person--that the person under review is to:
(i) give specified classes of associated persons specified information about the appropriate provision of services, or that is relevant to preventing inappropriate practice in the provision of services, in a specified form (if any) within a specified period; and
(ii) give the Chief Executive Medicare, within a specified period, specified evidence that the person under review has taken the action mentioned in subparagraph (i);
(da) if the person under review is a midwife and there is in force in respect of the person an undertaking under section 21B--that the Minister's acceptance of the undertaking is to be taken to be revoked;
(db) if the person under review is a nurse practitioner and there is in force in respect of the person an undertaking under section 22A--that the Minister's acceptance of the undertaking is to be taken to be revoked;
(e) if the person under review is a person in respect of whom a Part VII authority is in force and a service referred to in paragraph (1)(a) involves prescribing or supplying a pharmaceutical benefit--that the Part VII authority is to be taken, for the purposes of the National Health Act 1953 , to be suspended for a period of not more than 3 years starting when the agreement takes effect;
(f) if the person under review is a practitioner--that the person is to be disqualified, for a specified period starting when the agreement takes effect, in respect of one or more of the following:
(i) provision of specified services, or provision of services other than specified services;
(ii) provision of services to a specified class of persons, or provision of services to persons other than persons included in a specified class of persons;
(iii) provision of services within a specified location, or provision of services otherwise than in a specified location;
(g) if the person under review is a practitioner--that the person is to be fully disqualified for a specified period starting when the agreement takes effect.
Note: Medicare benefits and dental benefits are not payable in respect of services rendered or initiated by, or on behalf of, disqualified practitioners (see section 19B of this Act in relation to medicare benefits, and section 20A of the Dental Benefits Act 2008 in relation to dental benefits).
(2A) For the purposes of paragraphs (2)(f) and (g), the period specified must not be more than:
(a) if the person under review is a practitioner in relation to whom an agreement under this section, or a final determination under section 106TA, has previously taken effect--5 years; or
(b) in any other case--3 years.
(3) An agreement entered into between the Director and the person under review under subsection (1) does not take effect unless it is ratified by the Determining Authority.
(4) If the agreement is ratified by the Determining Authority:
(a) the agreement takes effect on:
(i) the date specified in the agreement; or
(ii) if no date is so specified or the agreement is not ratified on or before the date so specified--the 14th day after the day on which it is ratified; and
(b) the agreement is binding on the Director and the person under review; and
(c) the Director must notify the Chief Executive Medicare in writing of the making and ratification of the agreement and of the terms and date of effect of the agreement; and
(d) the Director must ensure that any action specified in the agreement under subsection (2) that is necessary to give effect to the agreement is taken; and
(da) if the Chief Executive Medicare is of the opinion that the person under review has not taken action specified in the agreement that is necessary to give effect to the agreement--the Chief Executive Medicare may notify the Director, in writing, of the Chief Executive Medicare's opinion together with the Chief Executive Medicare's reasons for that opinion; and
(e) if the agreement provides for the person under review to pay to the Commonwealth an amount equal to the whole or a specified part of any medicare benefit or dental benefit and the amount or a part of the amount is not paid--the unpaid amount is a debt due by the person to the Commonwealth and is recoverable by action in any court of competent jurisdiction; and
(f) if the agreement provides for the person under review to pay to the Commonwealth an amount equal to the whole or a specified part of the amount paid for treatment under a relevant DVA law and the amount or part of the amount is not paid--the unpaid amount is a debt due by the person to the Commonwealth and is recoverable by action in any court of competent jurisdiction.
Note: If the Chief Executive Medicare notifies the Director under paragraph (da), the Director may cause certain particulars to be published under section 106ZPR.
(4A) Before notifying the Director under paragraph (4)(da), the Chief Executive Medicare must:
(a) give the person under review a written notice that:
(i) sets out the reasons why the Chief Executive Medicare is of the opinion that the person has not taken action specified in the agreement that is necessary to give effect to the agreement; and
(ii) invites the person to make written submissions to the Chief Executive Medicare, within a specified period of not less than 14 days after the notice is given, about why the Chief Executive Medicare should not notify the Director under paragraph (4)(da); and
(b) consider any submissions made as mentioned in subparagraph (a)(ii).
(5) A refusal of the Determining Authority to ratify the agreement does not prevent the Director and the person under review from entering into a further agreement under subsection (1).
(6) The Director must not disclose to any Panel member (other than a Panel member consulted by the Director under paragraph 90(1)(a) in relation to the referral):
(a) the content of any communications between the Director and the person under review in relation to proposals for an agreement under this section; or
(b) whether any such communications have taken place.
(6A) This section applies as if a reference in this section to a practitioner included a reference to a person who has been a practitioner.
"associated person" , in relation to a person under review, has the meaning given by subsection 106U(5).
"Part VII authority" means any of the following authorities or approvals under Part VII of the National Health Act 1953 :
(a) the authority conferred on a medical practitioner by section 88 of that Act;
(b) the approval of a dental practitioner as a participating dental practitioner under section 84A of that Act;
(ba) the approval of an optometrist as an authorised optometrist under section 84AAB of that Act;
(bb) the approval of an eligible midwife as an authorised midwife under section 84AAF of that Act;
(bc) the approval of an eligible nurse practitioner as an authorised nurse practitioner under section 84AAJ of that Act;
(c) the approval of a medical practitioner under section 92 of that Act;
(d) the authority conferred on a medical practitioner by section
93 of that Act to supply pharmaceutical benefits.