Commonwealth Numbered Regulations

1985 No. 70 HEALTH INSURANCE COMMISSION REGULATIONS (AMENDMENT) - REG 2

2. After regulation 2A of the Health Insurance Commission Regulations the
following regulation is inserted: Additional functions of the
Commission-Investigation in relation to rendering by practitioners of
excessive services, &c.

"3. (1) In this regulation, unless the contrary intention appears-
'excessive services' has-

   (a)  in relation to a practitioner, the same meaning as in Division 3 of
        Part V of the Health Insurance Act; and

   (b)  in relation to an optometrist, the same meaning as in Division 3A of
        Part V of the Health Insurance Act;
'Health Insurance Act' means the Health Insurance Act 1973;
'initiation of a pathology service' has the same meaning as in Division 3 of
Part V of the Health Insurance Act;
'medicare benefit' has the same meaning as in the Health Insurance Act;
'optometrist' has the same meaning as in Division 3A of Part V of the Health 
Insurance Act ;
'practitioner' has the same meaning as in Division 3 of Part V of the Health 
Insurance Act .



"(2) For the purposes of sub-section 8E (1) of the Act, the following
functions are prescribed:

   (a)  to devise and implement measures intended-

        (i)    to prevent the rendering of excessive services by a
               practitioner or an optometrist or the initiation of excessive
               pathology services by a practitioner;

        (ii)   to facilitate the detection of cases where excessive services
               have been so rendered or excessive pathology services so
               initiated and the indentification of those services; or

        (iii)  to prevent, or facilitate the detection of, activities related
               to claims for payment, or the receipt, of medicare benefits
               that may constitute an offence under the Health Insurance Act
               or the Crimes Act 1914;

   (b)  to investigate cases where there are reasonable grounds to suspect
        that a practitioner or an optometrist may have rendered excessive
        services or a practitioner may have initiated excessive pathology
        services and, where an investigation discloses that there is
        sufficient evidence to warrant a referral of the case investigated to
        a Committee established under Division 3 or 3A of Part V of the
        Health Insurance Act, as the case may be, to refer the case and the
        information obtained in the course of the investigation, with
        appropriate comments and recommendations, to the Minister or the
        delegate of the Minister;

   (c)  to investigate cases where there are reasonable grounds to suspect
        that-

        (i)    an act done by a person in relation to a claim for payment, or
               the receipt, of medicare benefits may constitute an offence
               under the Health  Insurance Act or the Crimes Act 1914; or

        (ii)   a person may have committed an offence against sub-section 19D
               (2), 19D (7), 101 (1), 101 (2), 102 (1), 102 (1A), 106FF (1),
               106FF (2), 106FG (1) or 106FG (2) of the Health Insurance Act,
and, where an investigation discloses that there is sufficient evidence to
warrant a prosecution, to refer the case investigated and the information
obtained in the course of the investigation to the Australian Federal Police
or the Director of Public Prosecutions;

   (d)  to process, on behalf of the Minister, applications made, under
        sub-section (8) or (9) of section 19B of the Health Insurance Act, to
        the Minister by persons who are practitioners within the meaning of
        that section, to advise the Minister in relation to-

        (i)    the determinations to be made by the Minister in respect of
               those applications; and

        (ii)   the revocation under sub-section 19B (19) of that Act of any
               determination so made by the Minister,
and to undertake, on behalf of the Minister, such action as it is necessary
for the Minister to undertake in relation to any application, in accordance
with section 19E of that Act, to the Administrative Appeals Tribunal by a
practitioner for review of a decision of the Minister under sub-section 19B
(8), (9) or (19) of that Act;

   (e)  to undertake, as directed by the Minister, such action as is required
        of the Minister under the Act in relation to statements under
        sub-sections 19B (13) or 19C (2), (3) or (4) of the
        Health Insurance Act;

   (f)  to advise the Minister in relation to directions to be given by the
        Minister under section 19D of the Health Insurance Act and undertake,
        on behalf of the Minister, such action as is required under that Act
        in relation to those directions;

   (g)  to provide such clerical and administrative services as are necessary
        to enable-

        (i)    the Minister to exercise his or her powers under Divisions 3
               and 3A of Part V, and Divisions 3, 4 and 5 of Part VA, of the
               Health Insurance Act; and

        (ii)   the Committees established under Division 3 or 3A of Part V of
               that Act and the Tribunals established under Division 2 of Part
               VA of that Act to perform their functions under that Act;

   (h)  to undertake, on behalf of the Commonwealth, action (including the
        institution of legal proceedings) to recover from a person an amount
        of medicare benefit that is recoverable by the Commonwealth from that
        person under the Health Insurance Act or otherwise.".