Commonwealth Consolidated Acts

HEALTH INSURANCE ACT 1973 - SECT 92

             (1)  If the person under review is a practitioner, the Director and the person may enter into a written agreement under which:

                     (a)  the person acknowledges that the person engaged in inappropriate practice in connection with rendering or initiating specified services during the review period; and

                     (b)  specified action in relation to the person (being action of a kind mentioned in subsection (2)) is to take effect.

             (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;

                     (b)  if any medicare benefit has been paid (whether or not to the person) for services referred to in paragraph (1)(a)--that the person is to repay to the Commonwealth an amount equal to the whole or a specified part of that medicare benefit;

                     (c)  that any medicare benefit that would otherwise be payable for services referred to in paragraph (1)(a) is to cease to be payable;

                     (d)  if the person is a participating optometrist--that the Minister's acceptance of the undertaking by the participating optometrist under section 23B is to be taken to be revoked, either wholly or in so far as the undertaking covers particular premises;

                   (da)  if the person 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 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 is a person in respect of whom a Part VII authority is in force and a service referred to in that paragraph involves prescribing or dispensing 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)  that the person is to be disqualified, for a specified period of not more than 3 years 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)  that the person is to be fully disqualified for a specified period of not more than 3 years starting when the agreement takes effect.

Note:          Medicare benefits are not payable in respect of services rendered or initiated by, or on behalf of, disqualified practitioners (see section 19B).

             (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

                     (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 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)  the agreement is taken to be a final determination of the Determining Authority for the purposes of section 106X.

             (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.

             (7)  In this section:

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.