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DENTAL BENEFITS LEGISLATION AMENDMENT BILL 2014

 

 

 

2013-2014 

 

The Parliament of the 

Commonwealth of Australia 

 

HOUSE OF REPRESENTATIVES 

 

 

 

 

Presented and read a first time 

 

 

 

 

Dental Benefits Legislation Amendment 

Bill 2014 

 

No.      , 2014 

 

(Health) 

 

 

 

A Bill for an Act to amend legislation in relation to 

dental benefits, and for other purposes 

   

   

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

i 

 

Contents 

Short title ........................................................................................... 1

 

Commencement ................................................................................. 1

 

Schedule(s) ........................................................................................ 2

 

Schedule 1--Amendments

 

3

 

Part 1--Professional Services Review Scheme

 

3

 

Dental Benefits Act 2008

 

3

 

Health Insurance Act 1973

 

7

 

Part 2--Waiver of debts arising in relation to the Chronic 

Disease Dental Scheme

 

12

 

Health Insurance Act 1973

 

12

 

Part 3--Compliance

 

15

 

Dental Benefits Act 2008

 

15

 

Part 4--Delegation of Ministerial powers

 

30

 

Dental Benefits Act 2008

 

30

 

Part 5--Dental providers

 

31

 

Dental Benefits Act 2008

 

31

 

Part 6--Provision of information

 

32

 

Dental Benefits Act 2008

 

32

 

Part 7--Technical amendment

 

33

 

Dental Benefits Act 2008

 

33

 

 

 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

1 

 

A Bill for an Act to amend legislation in relation to 

dental benefits, and for other purposes 

The Parliament of Australia enacts: 

1  Short title 

 

  This Act may be cited as the Dental Benefits Legislation 

Amendment Act 2014

2  Commencement 

 

  This Act commences on the day after this Act receives the Royal 

Assent. 

   

   

 

 

2 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

3  Schedule(s) 

 

  Each Act that is specified in a Schedule to this Act is amended or 

repealed as set out in the applicable items in the Schedule 

concerned, and any other item in a Schedule to this Act has effect 

according to its terms. 

Amendments  Schedule 1 

Professional Services Review Scheme  Part 1 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

3 

 

Schedule 1

--Amendments 

Part 1

--Professional Services Review Scheme 

Dental Benefits Act 2008 

1  Section 4 

Insert: 

disqualified practitioner: a dental practitioner is a disqualified 

practitioner if: 

 

(a)  the dental practitioner is fully disqualified under an 

agreement in effect under section 92 of the Health Insurance 

Act 1973; or 

10 

 

(b)  the dental practitioner is fully disqualified under section 105 

11 

of that Act; or 

12 

 

(c)  a final determination under section 106TA of that Act 

13 

containing a direction under paragraph 106U(1)(h) of that 

14 

Act that the dental practitioner be fully disqualified is in 

15 

effect. 

16 

Note: 

Under section 106ZPM of the Health Insurance Act 1973 (which deals 

17 

with failure to produce certain documents or give certain information), 

18 

a person may be taken to be a disqualified practitioner for the 

19 

purposes of sections 20B to 20E of this Act. 

20 

partly disqualified practitioner: a dental practitioner is a partly 

21 

disqualified practitioner in relation to a dental service if: 

22 

 

(a)  the dental practitioner is partly disqualified under an 

23 

agreement in effect under section 92 of the Health Insurance 

24 

Act 1973 in respect of the service; or 

25 

 

(b)  a final determination under section 106TA of that Act 

26 

containing a direction under paragraph 106U(1)(g) of that 

27 

Act that the dental practitioner be partly disqualified is in 

28 

effect in respect of the service. 

29 

2  Section 10 

30 

Omit: 

31 

•  

Dental benefit is not payable in certain circumstances. 

32 

Schedule 1  Amendments 

Part 1  Professional Services Review Scheme 

 

 

4 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

substitute: 

•  

Dental benefit is not payable in certain circumstances, 

including where a dental service is provided by a practitioner 

who has been disqualified under the Health Insurance Act 

1973

•  

The Minister may direct a disqualified practitioner to give 

notice of his or her disqualification. 

3  After section 20 

Insert: 

20A  Dental benefit is not payable in respect of a dental service 

10 

rendered by a disqualified practitioner 

11 

 

  Dental benefit is not payable in respect of a dental service if, at the 

12 

time when the service was rendered, the person who rendered the 

13 

service, or the dental provider on whose behalf the service was 

14 

rendered, was: 

15 

 

(a)  a disqualified practitioner; or 

16 

 

(b)  a partly disqualified practitioner in relation to the service. 

17 

20B  Minister may direct disqualified practitioner to give notice of 

18 

disqualification 

19 

 

(1)  The Minister may, by written instrument served on a disqualified 

20 

practitioner or a partly disqualified practitioner (the practitioner), 

21 

direct the practitioner, and persons acting on behalf of the 

22 

practitioner, not to render a specified dental service in respect of 

23 

which, under section 20A of this Act or section 106ZPM of the 

24 

Health Insurance Act 1973, dental benefit is not payable unless, 

25 

before beginning to render the service, the practitioner or a person 

26 

acting on behalf of the practitioner: 

27 

 

(a)  gives a copy of the notice under subsection (2) to the person 

28 

(the service recipient) to whom the dental service is to be 

29 

rendered; and 

30 

 

(b)  if the practitioner or person acting on behalf of the 

31 

practitioner has reasonable grounds for believing that the 

32 

service recipient is, or may be, unable to read and understand 

33 

Amendments  Schedule 1 

Professional Services Review Scheme  Part 1 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

5 

 

the notice--takes reasonable steps to explain the contents of 

the notice to the service recipient or to another person who 

has care of the service recipient. 

Note: 

Failure to comply with a direction given under this section is an 

offence (see section 20C). 

 

(2)  The instrument must: 

 

(a)  be accompanied by a notice: 

 

(i)  setting out particulars of the disqualification; and 

 

(ii)  explaining such of the effects of the disqualification as 

the Minister considers appropriate; and 

10 

 

(b)  specify the day on which the direction comes into effect, 

11 

which must not be before the instrument is served on the 

12 

practitioner. 

13 

Period during which direction remains in force 

14 

 

(3)  Unless sooner revoked, a direction under subsection (1) in relation 

15 

to a disqualified practitioner, or a partly disqualified practitioner, 

16 

remains in force until the practitioner ceases to be a disqualified 

17 

practitioner or a partly disqualified practitioner. 

18 

Legislative instrument 

19 

 

(4)  An instrument made under subsection (1), or a notice 

20 

accompanying the instrument under subsection (2), is not a 

21 

legislative instrument. 

22 

20C  Strict liability offence--failure to comply with direction to give 

23 

notice of disqualification 

24 

 

(1)  A person (the first person) commits an offence if: 

25 

 

(a)  the first person is a disqualified practitioner or a partly 

26 

disqualified practitioner; and 

27 

 

(b)  an instrument is served on the first person under section 20B; 

28 

and 

29 

 

(c)  the instrument contains a direction; and 

30 

 

(d)  the first person: 

31 

 

(i)  fails to comply with the direction; or 

32 

 

(ii)  causes or permits a person acting on his or her behalf to 

33 

fail to comply with the direction. 

34 

Schedule 1  Amendments 

Part 1  Professional Services Review Scheme 

 

 

6 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

Penalty:  1 penalty unit. 

 

(2)  An offence against subsection (1) is an offence of strict liability. 

Note: 

For strict liability, see section 6.1 of the Criminal Code

 

(3)  Subsection (1) does not apply if the first person has a reasonable 

excuse. 

Note: 

A defendant bears an evidential burden in relation to the matter in 

subsection (3): see subsection 13.3(3) of the Criminal Code

20D  Minister may direct disqualified practitioner to display notice 

of disqualification 

 

(1)  The Minister may, by written instrument served on a disqualified 

10 

practitioner or a partly disqualified practitioner (the practitioner), 

11 

direct the practitioner to display one or more notices under 

12 

subsection (2): 

13 

 

(a)  in a specified place or places; and 

14 

 

(b)  in a specified manner. 

15 

Note: 

Failure to comply with a direction given under this subsection is an 

16 

offence (see section 20E). 

17 

 

(2)  The instrument must: 

18 

 

(a)  be accompanied by one or more notices: 

19 

 

(i)  setting out particulars of the disqualification; and 

20 

 

(ii)  explaining such of the effects of the disqualification as 

21 

the Minister considers appropriate; and 

22 

 

(b)  specify the day on which the direction comes into effect, 

23 

which must not be before the instrument is served on the 

24 

practitioner. 

25 

 

(3)  No more than one direction under subsection (1) may be in force in 

26 

relation to the practitioner at any time. 

27 

Period during which direction remains in force 

28 

 

(4)  Unless sooner revoked, a direction under subsection (1) in relation 

29 

to a disqualified practitioner, or a partly disqualified practitioner, 

30 

remains in force until the practitioner ceases to be a disqualified 

31 

practitioner or a partly disqualified practitioner. 

32 

Amendments  Schedule 1 

Professional Services Review Scheme  Part 1 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

7 

 

Legislative instrument 

 

(5)  An instrument made under subsection (1), or a notice 

accompanying the instrument under subsection (2), is not a 

legislative instrument. 

20E  Strict liability offence--failure to comply with direction to 

display notice of disqualification 

 

(1)  A person commits an offence if: 

 

(a)  the person is a disqualified practitioner or a partly 

disqualified practitioner; and 

 

(b)  an instrument is served on the practitioner under section 20D; 

10 

and 

11 

 

(c)  the instrument contains a direction; and 

12 

 

(d)  the person fails to comply with the direction. 

13 

Penalty:  1 penalty unit. 

14 

 

(2)  An offence against subsection (1) is an offence of strict liability. 

15 

Note: 

For strict liability, see section 6.1 of the Criminal Code

16 

 

(3)  A person who commits an offence against subsection (1) commits 

17 

a separate offence in respect of each day (including the day of a 

18 

conviction under this section or any later day) during which the 

19 

offence continues. 

20 

 

(4)  Subsection (1) does not apply if the person has a reasonable 

21 

excuse. 

22 

Note: 

A defendant bears an evidential burden in relation to the matter in 

23 

subsection (4): see subsection 13.3(3) of the Criminal Code

24 

4  Paragraphs 35(a) and (b) 

25 

After "this Act", insert "or the Health Insurance Act 1973". 

26 

Health Insurance Act 1973 

27 

5  Subsection 3(1) 

28 

Insert: 

29 

Schedule 1  Amendments 

Part 1  Professional Services Review Scheme 

 

 

8 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

dental benefit has the same meaning as in the Dental Benefits Act 

2008

relevant dental benefits offence means: 

 

(a)  an offence against section 50, 51, 52, 53 or 54 of the Dental 

Benefits Act 2008; or 

 

(b)  an offence against: 

 

(i)  section 6 of the Crimes Act 1914; or 

 

(ii)  section 11.1, 11.4 or 11.5 of the Criminal Code

 

  that relates to an offence referred to in paragraph (a) of this 

definition; or 

10 

 

(c)  an offence against section 134.1, 134.2, 135.1, 135.2, 135.4, 

11 

136.1, 137.1, 144.1, 145.1, 145.4 or 145.5 of the Criminal 

12 

Code that relates to a claim for payment in respect of the 

13 

rendering of a dental service (within the meaning of the 

14 

Dental Benefits Act 2008). 

15 

6  Section 79A 

16 

After "medicare benefits", insert ", dental benefits". 

17 

7  Subsections 80A(1) and (2) 

18 

After "medicare benefit", insert "or dental benefit". 

19 

8  Subsection 81(1) (paragraph (a) of the definition of service

20 

After "medicare benefit", insert "or dental benefit". 

21 

9  Subsection 81(1) (note at the end of the definition of 

22 

service

23 

After "Note", insert "1". 

24 

10  Subsection 81(1) (at the end of the definition of service

25 

Add: 

26 

Note 2: 

See the Dental Benefits Act 2008 for when a dental benefit is payable. 

27 

11  Section 89A (heading) 

28 

Repeal the heading, substitute: 

29 

Amendments  Schedule 1 

Professional Services Review Scheme  Part 1 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

9 

 

89A  Director may refer material to Chief Executive Medicare if 

certain offences or civil contraventions are suspected 

12  Subsection 89A(1) 

After "section 124B,", insert "or a relevant dental benefits offence,". 

13  Paragraphs 92(2)(b) and (c) 

After "medicare benefit" (wherever occurring), insert "or dental 

benefit". 

14  Subsection 92(2) (note) 

Repeal the note, substitute: 

Note: 

Medicare benefits and dental benefits are not payable in respect of 

10 

services rendered or initiated by, or on behalf of, disqualified 

11 

practitioners (see section 19B of this Act in relation to medicare 

12 

benefits, and section 20A of the Dental Benefits Act 2008 in relation to 

13 

dental benefits). 

14 

15  Paragraph 92(4)(e) 

15 

After "medicare benefit", insert "or dental benefit". 

16 

16  Section 106N (heading) 

17 

Repeal the heading, substitute: 

18 

106N  Committee may refer material to Chief Executive Medicare if 

19 

certain offences or civil contraventions are suspected 

20 

17  Subsection 106N(1) 

21 

After "section 124B,", insert "or a relevant dental benefits offence,". 

22 

18  Paragraphs 106U(1)(c) and (ca) 

23 

After "medicare benefit" (wherever occurring), insert "or dental 

24 

benefit". 

25 

19  Paragraph 106U(1)(cb) 

26 

After "medicare benefits" (wherever occurring), insert "or dental 

27 

benefits". 

28 

Schedule 1  Amendments 

Part 1  Professional Services Review Scheme 

 

 

10 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

20  Subsection 106U(1) (note) 

Repeal the note, substitute: 

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). 

21  Subsection 106ZPM(1) 

After "medicare benefit", insert "or dental benefit". 

22  Subsection 106ZPM(2) 

10 

After "medicare benefits", insert "and dental benefits". 

11 

23  Paragraph 106ZPM(4)(a) 

12 

After "medicare benefits", insert "and dental benefits". 

13 

24  Subsection 106ZPM(4) 

14 

Omit all the words after "the person is", substitute: 

15 

taken to be: 

16 

 

(c)  fully disqualified at that time for the purposes of section 19D; 

17 

and 

18 

 

(d)  a disqualified practitioner for the purposes of sections 20B to 

19 

20E of the Dental Benefits Act 2008

20 

25  Subsection 106ZR(1) 

21 

After "this Act" (wherever occurring), insert "or the Dental Benefits Act 

22 

2008". 

23 

26  Subsection 129AAC(1) 

24 

Omit "or relevant civil contravention", substitute ", relevant civil 

25 

contravention or relevant dental benefits offence". 

26 

27  Application of amendments 

27 

(1) 

The amendments made by this Part (other than items 12, 17 and 26) 

28 

apply in relation to services provided on or after the day this Part 

29 

commences. 

30 

Amendments  Schedule 1 

Professional Services Review Scheme  Part 1 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

11 

 

(2) 

The amendments made by items 12 and 17 apply in relation to relevant 

dental benefits offences committed on or after the day this Part 

commences. 

(3) 

The amendment made by item 26 applies in relation to relevant dental 

benefits offences whether committed before, on or after the day this Part 

commences. 

Schedule 1  Amendments 

Part 2  Waiver of debts arising in relation to the Chronic Disease Dental Scheme 

 

 

12 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

Part 2

--Waiver of debts arising in relation to the 

Chronic Disease Dental Scheme 

Health Insurance Act 1973 

28  After section 129AEC 

Insert: 

129AED  Waiver and repayment of certain debts arising under the 

Chronic Disease Dental Scheme 

When this section applies 

 

(1)  This section applies in relation to a purported payment of medicare 

benefit in respect of a service referred to in Schedule 1 to the 

10 

Health Insurance (Dental Services) Determination 2007 if: 

11 

 

(a)  the service was provided by a dental practitioner; and 

12 

 

(b)  the payment exceeded the amount (if any) that should have 

13 

been paid; and 

14 

 

(c)  there was a failure to comply with subsection 10(2) 

15 

(quotation for dental services and reporting) of the 

16 

Determination in relation to the service; and 

17 

 

(d)  the Chief Executive Medicare is satisfied that the excess is 

18 

solely attributable to the failure to comply with 

19 

subsection 10(2) of the Determination. 

20 

Note: 

The Determination was made under subsection 3C(1) of this Act. It 

21 

ceased at midnight 30 November 2012 (see section 2A of the 

22 

Determination). 

23 

 

(2)  However, this section does not apply in relation to a purported 

24 

payment of medicare benefit in respect of a service that was 

25 

rendered on or after 1 April 2010 unless, before the end of 

26 

30 November 2014, the dental practitioner provides or has 

27 

provided the Chief Executive Medicare with evidence that the 

28 

documents that, under subsection 10(2) of the Determination, 

29 

should have been given to the patient and general practitioner 

30 

before the relevant course of treatment began have since been 

31 

given to those persons. 

32 

Amendments  Schedule 1 

Waiver of debts arising in relation to the Chronic Disease Dental Scheme  Part 2 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

13 

 

Waiver and repayment of debts 

 

(3)  If the excess, or part of the excess, is recoverable under 

section 129AC as a debt due to the Commonwealth, the Chief 

Executive Medicare must, on behalf of the Commonwealth, waive 

the debt. 

 

(4)  If the excess, or part of the excess: 

 

(a)  has been repaid to the Commonwealth by a person (or a 

person's estate); or 

 

(b)  has otherwise been recovered by the Commonwealth from a 

person (or a person's estate), including by way of set-off; 

10 

the Chief Executive Medicare must, on behalf of the 

11 

Commonwealth, pay to the person (or to the person's estate) the 

12 

amount paid or recovered. 

13 

 

(5)  An amount payable under subsection (4) is reduced by any amount 

14 

already paid by the Commonwealth in respect of the repaid or 

15 

recovered amount. 

16 

 

(6)  A reference in subsection (3), (4) or (5) to an excess includes: 

17 

 

(a)  any amount of administrative penalty for which the dental 

18 

practitioner is liable to the Commonwealth under 

19 

section 129AEA in relation to the excess; and 

20 

 

(b)  any interest paid or payable in relation to the excess under 

21 

subsection 129AC(2) or (3). 

22 

129AEE  Notice of decision to waive, or not to waive, a debt 

23 

 

(1)  The Chief Executive Medicare must give written notice of the 

24 

following decisions: 

25 

 

(a)  a decision to waive a debt under subsection 129AED(3); 

26 

 

(b)  a decision to pay an amount under subsection 129AED(4); 

27 

 

(c)  a decision not to waive a debt under subsection 129AED(3), 

28 

or not to pay an amount under subsection 129AED(4), 

29 

because the Chief Executive Medicare is not satisfied of the 

30 

matter referred to in paragraph 129AED(1)(d). 

31 

 

(2)  The notice must be given to the dental practitioner who provided 

32 

the service referred to in subsection 129AED(1), or to his or her 

33 

estate. 

34 

Schedule 1  Amendments 

Part 2  Waiver of debts arising in relation to the Chronic Disease Dental Scheme 

 

 

14 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

 

(3)  A failure to give notice under this section of a decision does not 

affect the validity of the decision. 

Amendments  Schedule 1 

Compliance  Part 3 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

15 

 

Part 3

--Compliance 

Dental Benefits Act 2008 

29  Section 3 

Omit: 

•  

This Act also makes provision in relation to the disclosure of 

information, offences against this Act and other matters. 

substitute: 

•  

This Act also makes provision in relation to the obtaining of 

documents relevant to ascertaining whether amounts should 

have been paid, the disclosure of information, offences against 

10 

this Act and other matters. 

11 

30  Section 4 

12 

Insert: 

13 

Human Services employee means a Departmental employee, 

14 

within the meaning of the Human Services (Medicare) Act 1973

15 

medical practitioner has the same meaning as in the Health 

16 

Insurance Act 1973

17 

medicare number has the same meaning as in subsection 84(1) of 

18 

the National Health Act 1953

19 

31  After Part 4 

20 

Insert: 

21 

Schedule 1  Amendments 

Part 3  Compliance 

 

 

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Part 4A--Power to obtain documents etc. relevant 

to ascertaining whether amounts should 

have been paid 

   

32A  Simplified outline 

 

  The following is a simplified outline of this Part: 

•  

The Chief Executive Medicare may require the production of 

documents etc. relevant to ascertaining whether amounts 

should have been paid. 

•  

A failure to comply may lead to debt recovery action or to a 

10 

civil penalty. 

11 

•  

The Chief Executive Medicare and Human Services 

12 

employees may deal with documents etc. produced. 

13 

32B  When this Part applies 

14 

 

(1)  This Part applies if the Chief Executive Medicare: 

15 

 

(a)  has a reasonable concern that an amount paid, purportedly by 

16 

way of dental benefit, in respect of one or more dental 

17 

services, may exceed the amount (if any) that should have 

18 

been paid; and 

19 

 

(b)  has taken into account advice given to him or her by a dental 

20 

practitioner, or a medical practitioner, who is a Human 

21 

Services employee about the types of documents that contain 

22 

information relevant to ascertaining whether amounts paid in 

23 

respect of dental services of the same kind or kinds as the 

24 

service or services referred to in paragraph (a) should have 

25 

been paid; and 

26 

 

(c)  has taken reasonable steps to consult with a relevant 

27 

professional body about the types of documents that contain 

28 

information relevant to ascertaining whether amounts paid in 

29 

respect of dental services of the same kind or kinds as the 

30 

service or services referred to in paragraph (a) should have 

31 

been paid. 

32 

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Note: 

For the purposes of paragraph (a), the Chief Executive Medicare may, 

for example, have a reasonable concern about payments made in 

respect of: 

(a)  dental services rendered by or on behalf of individual dental 

providers; or 

(b)  dental services rendered by or on behalf of particular kinds of 

dental providers; or 

(c)  the rendering of dental services to which specific items, or 

groups of items, relate. 

 

(2)  In forming a reasonable concern for the purposes of subsection (1), 

10 

the Chief Executive Medicare is not to take account of whether the 

11 

service is clinically relevant. 

12 

Definition 

13 

 

(3)  In this section: 

14 

relevant professional body means a body declared by the Minister 

15 

under subsection (4) to be a relevant professional body. 

16 

 

(4)  The Minister may, by legislative instrument, declare a body to be a 

17 

relevant professional body for the purposes of this section. 

18 

32C  Chief Executive Medicare may require person to produce 

19 

documents etc. 

20 

Power to give notice requiring production of documents etc. 

21 

 

(1)  If the Chief Executive Medicare believes on reasonable grounds 

22 

that: 

23 

 

(a)  a person: 

24 

 

(i)  who rendered a dental service in respect of which an 

25 

amount has been paid that is the subject of the Chief 

26 

Executive Medicare's concern referred to in 

27 

paragraph 32B(1)(a); or 

28 

 

(ii)  on whose behalf such a dental service was rendered; or 

29 

 

(b)  another person, not being: 

30 

 

(i)  the person in respect of whom the dental service was 

31 

rendered; or 

32 

 

(ii)  the person who incurred the dental expenses in respect 

33 

of the service; 

34 

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has possession, custody or control of one or more documents 

relevant to ascertaining whether the amount paid in respect of the 

dental service should have been paid, the Chief Executive 

Medicare may, by written notice given to the person, require the 

person to do any or all of the things mentioned in subsection (2) 

within a period specified in the notice. 

Note: 

For a person referred to in paragraph (a), failure to comply with a 

notice may lead to debt recovery action (see section 56A). For a 

person referred to in paragraph (b), failure to comply with a notice 

may lead to a civil penalty (see section 32D). 

10 

 

(2)  The Chief Executive Medicare may require the person, in relation 

11 

to each dental service specified in the notice: 

12 

 

(a)  subject to subsection (3), to produce to the Chief Executive 

13 

Medicare, or a Human Services employee, any document, or 

14 

extract of any document, that is relevant for the purpose set 

15 

out in subsection (1); or 

16 

 

(b)  to make a copy of any such document or extract and to 

17 

produce that copy to the Chief Executive Medicare or a 

18 

Human Services employee. 

19 

 

(3)  If a document, extract or copy contains clinical details relating to 

20 

an individual, the person to whom the notice is given is not 

21 

required to produce the document, extract or copy to a person other 

22 

than a Human Services employee who is a dental practitioner or a 

23 

medical practitioner. 

24 

Limitations on power to give notice: person must first have been 

25 

given opportunity to respond to a request 

26 

 

(4)  The Chief Executive Medicare must not give a notice to a person 

27 

under subsection (1) in respect of a dental service unless the Chief 

28 

Executive Medicare has given the person a reasonable opportunity 

29 

to respond to a written request (other than under this section) to 

30 

produce to the Chief Executive Medicare, or a Human Services 

31 

employee, documents relevant to ascertaining whether the amount 

32 

paid, purportedly by way of dental benefit, in respect of the 

33 

service, should have been paid. 

34 

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Limitations on power to give notice: notice can only be given in 

respect of dental service rendered in the last 2 years 

 

(5)  A notice under subsection (1) can only be given in respect of a 

dental service that was rendered in the period of 2 years 

immediately before the notice is given. 

Content of notice 

 

(6)  A notice under subsection (1) must: 

 

(a)  specify details of each dental service (including the item, date 

on which the service was rendered and medicare number of 

the person in respect of whom the service was rendered) in 

10 

relation to which the document, extract or copy is to be 

11 

produced; and 

12 

 

(b)  specify the reason or reasons for the Chief Executive 

13 

Medicare's concern that an amount paid, purportedly by way 

14 

of dental benefit, in respect of each such service may exceed 

15 

the amount (if any) that should have been paid; and 

16 

 

(c)  specify the information relevant to ascertaining whether 

17 

amounts paid in respect of each such service should have 

18 

been paid; and 

19 

 

(d)  specify how the document, extract or copy is to be produced; 

20 

and 

21 

 

(e)  contain a statement to the effect that the person to whom the 

22 

notice is given is not expected to produce a document, extract 

23 

or copy containing clinical details relating to an individual 

24 

unless the document, extract or copy is necessary to 

25 

ascertaining whether the amount paid in respect of the service 

26 

should have been paid; and 

27 

 

(f)  specify the period within which, and place at which, the 

28 

document, extract or copy is to be produced. 

29 

The period specified under paragraph (f) must be a period ending 

30 

at least 21 days after the day on which the notice is given. 

31 

Note: 

For the purpose of paragraphs (b) and (c) the notice will include the 

32 

reason for the Chief Executive Medicare's concern about the payment 

33 

and explain the factual issue that the person is required to substantiate. 

34 

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Health information within the meaning of the Privacy Act 1988 

 

(7)  The power under this section to require a document, extract or 

copy to be produced includes the power to require the production 

of a document, extract or copy containing health information 

(within the meaning of the Privacy Act 1988) about an individual. 

Section is not limited by other provisions 

 

(8)  This section is not limited by: 

 

(a)  any other provision of this Act; or 

 

(b)  any provision of the Human Services (Medicare) Act 1973 or 

any other Act; 

10 

that relates to the powers of the Chief Executive Medicare to 

11 

require the production of documents. 

12 

32D  Civil penalty--failure to comply with requirement in notice 

13 

 

(1)  A person referred to in paragraph 32C(1)(b) contravenes this 

14 

section if: 

15 

 

(a)  the person is given a notice under section 32C requiring the 

16 

person to do something in respect of a dental service; and 

17 

 

(b)  the person fails to comply with the requirement within the 

18 

period specified in the notice. 

19 

Civil penalty: 

20 

 

(a)  for an individual--20 penalty units; and 

21 

 

(b)  for a body corporate--100 penalty units. 

22 

 

(2)  It is a defence in proceedings against a person for a contravention 

23 

of subsection (1) if the person proves (on the balance of 

24 

probabilities) that: 

25 

 

(a)  the failure to comply is brought about by another person over 

26 

whom the person has no control or by a non-human act or 

27 

event over which the person has no control; and 

28 

 

(b)  the person could not reasonably be expected to guard against 

29 

the failure. 

30 

 

(3)  Part VIA of the Health Insurance Act 1973 applies in relation to 

31 

this section as if subsection (1) of this section were a civil penalty 

32 

provision as defined in section 125B of that Act. 

33 

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Note: 

Part VIA of the Health Insurance Act 1973 provides a regime for the 

obtaining of orders for a civil penalty. 

32E  Self-incrimination etc. 

 

(1)  A person is not excused from producing a document, extract or 

copy when required to do so under section 32C on the ground that 

doing so would tend to incriminate the person or expose the person 

to a penalty. 

 

(2)  However, in the case of an individual: 

 

(a)  the document, extract or copy produced; and 

 

(b)  producing the document, extract or copy; and 

10 

 

(c)  any information, document or thing obtained as a direct or 

11 

indirect consequence of producing the document, extract or 

12 

copy; 

13 

are not admissible in evidence against the individual in: 

14 

 

(d)  any criminal proceedings, other than: 

15 

 

(i)  proceedings for an offence against this Act dealing with 

16 

false or misleading statements; and 

17 

 

(ii)  proceedings for an offence against section 137.1 or 

18 

137.2 of the Criminal Code (which deals with false or 

19 

misleading information or documents) that relates to 

20 

this Act; or 

21 

 

(e)  any civil proceedings, other than a civil proceeding arising 

22 

under section 32D, or Division 4 of Part 6, of this Act. 

23 

32F  Chief Executive Medicare or Human Services employee may 

24 

deal with documents etc. produced 

25 

Power to inspect, copy and retain document etc. 

26 

 

(1)  If a document, extract or copy has been produced under 

27 

section 32C in respect of a dental service, the Chief Executive 

28 

Medicare, or a Human Services employee, may do all or any of the 

29 

things mentioned in subsection (2) for the purpose of ascertaining 

30 

whether the information contained in the document, extract or copy 

31 

properly substantiates that an amount paid, purportedly by way of 

32 

dental benefit, in respect of the service, should have been paid. 

33 

Note: 

If the information does not properly substantiate the amount, debt 

34 

recovery action may be taken (see section 56A). 

35 

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(2)  The Chief Executive Medicare or Human Services employee may: 

 

(a)  inspect the document, extract or copy; and 

 

(b)  make a copy of, or take an extract from, the document, 

extract or copy; and 

 

(c)  retain the document, extract or copy in his or her possession 

for such reasonable period as he or she thinks fit. 

Rights of person otherwise entitled to possession of document or 

extract 

 

(3)  The person otherwise entitled to possession of the document or 

extract is entitled to be supplied, as soon as practicable, with a 

10 

copy certified by the Chief Executive Medicare, or a Human 

11 

Services employee, to be a true copy. 

12 

 

(4)  The certified copy must be received in all courts and tribunals as 

13 

evidence as if it were the original. 

14 

 

(5)  Until a certified copy is supplied, the Chief Executive Medicare, or 

15 

a Human Services employee, must, at such times and places as he 

16 

or she thinks appropriate, permit the person otherwise entitled to 

17 

possession of the document or extract, or a person authorised by 

18 

that person, to inspect and make copies of, or take extracts from, 

19 

the document or extract. 

20 

Section is not limited by other provisions 

21 

 

(6)  This section is not limited by: 

22 

 

(a)  any other provision of this Act; or 

23 

 

(b)  any provision of the Human Services (Medicare) Act 1973 or 

24 

any other Act; 

25 

that relates to the powers of the Chief Executive Medicare, or a 

26 

Human Services employee, to deal with a document, extract or 

27 

copy as described in subsection (2) of this section. 

28 

Human Services employees 

29 

 

(7)  A Human Services employee referred to in this section may be an 

30 

employee other than the employee to whom the document, extract 

31 

or copy was required to be produced. 

32 

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32  Paragraph 34(2)(b) 

Repeal the paragraph, substitute: 

 

(b)  a Human Services employee; 

33  Section 47 

Omit: 

•  

Division 4 of this Part deals with the recovery of amounts paid 

because of false or misleading statements. 

substitute: 

•  

Division 4 of this Part deals with the recovery of amounts paid 

under this Act. 

10 

34  Division 4 of Part 6 (heading) 

11 

Repeal the heading, substitute: 

12 

Division 4--Recovery of amounts paid under this Act 

13 

35  Section 56 (heading) 

14 

Repeal the heading, substitute: 

15 

56  Recovery of amounts paid: false or misleading statements 

16 

36  At the end of subsection 56(2) 

17 

Add: 

18 

Note: 

See section 56D for review of decisions. 

19 

37  After section 56 

20 

Insert: 

21 

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Part 3  Compliance 

 

 

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No.      , 2014 

 

56A  Recovery of amounts paid: requirements under Part 4A to 

produce documents 

Failure to produce document: notice to person referred to in 

paragraph 32C(1)(a) 

 

(1)  If: 

 

(a)  a person referred to in paragraph 32C(1)(a) is required, by a 

notice given under section 32C, to produce a document, 

extract or copy in respect of a dental service; and 

 

(b)  the person does not comply with the requirement within the 

period specified in the notice; 

10 

the amount paid, purportedly by way of dental benefit, in respect of 

11 

the service, is recoverable as a debt due to the Commonwealth 

12 

from the person, or the estate of the person. 

13 

 

(2)  Subsection (1) does not apply if the person concerned satisfies the 

14 

Chief Executive Medicare that the person's non-compliance is due 

15 

to circumstances beyond the person's control. 

16 

Note: 

See section 56D for review of decisions. 

17 

Amount not properly substantiated: notice to person referred to in 

18 

paragraph 32C(1)(a) 

19 

 

(3)  If: 

20 

 

(a)  a person referred to in paragraph 32C(1)(a) is required, by a 

21 

notice given under section 32C, to produce a document, 

22 

extract or copy in respect of a dental service; and 

23 

 

(b)  the person complies with the requirement within the period 

24 

specified in the notice; and 

25 

 

(c)  the information contained in the document, extract or copy 

26 

does not properly substantiate (wholly or partly) that the 

27 

amount paid, purportedly by way of dental benefit, in respect 

28 

of the service, should have been paid; 

29 

then, to the extent that the amount is not properly substantiated, the 

30 

amount is recoverable as a debt due to the Commonwealth from 

31 

the person, or the estate of the person. 

32 

 

(4)  Subsection (3) does not apply if the person concerned satisfies the 

33 

Chief Executive Medicare that the reason that the information 

34 

contained in the document, extract or copy does not properly 

35 

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Compliance  Part 3 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

25 

 

substantiate the amount is due to circumstances beyond the 

person's control. 

Note: 

See section 56D for review of decisions. 

Amount not properly substantiated: notice to person referred to in 

paragraph 32C(1)(b) 

 

(5)  If: 

 

(a)  a person (the notice recipient) referred to in 

paragraph 32C(1)(b) is required, by a notice given under 

section 32C, to produce a document, extract or copy in 

respect of a dental service; and 

10 

 

(b)  the notice recipient complies with the requirement within the 

11 

period specified in the notice; and 

12 

 

(c)  the information contained in the document, extract or copy 

13 

does not properly substantiate (wholly or partly) that the 

14 

amount paid, purportedly by way of dental benefit, in respect 

15 

of the service, should have been paid; 

16 

then, to the extent that the amount is not properly substantiated, the 

17 

amount is recoverable as a debt due to the Commonwealth from: 

18 

 

(d)  the person who rendered the service, or on whose behalf the 

19 

service was rendered; or 

20 

 

(e)  the estate of that person. 

21 

 

(6)  Subsection (5) does not apply if the person from whom the amount 

22 

concerned is recoverable satisfies the Chief Executive Medicare 

23 

that the reason that the information contained in the document, 

24 

extract or copy does not properly substantiate the amount is due to 

25 

circumstances beyond the control of the person and the notice 

26 

recipient. 

27 

Note: 

See section 56D for review of decisions. 

28 

Amount is recoverable from a person under this section whether or 

29 

not the amount was paid to that person 

30 

 

(7)  An amount is recoverable from a person as mentioned in 

31 

subsection (1), (3) or (5) whether or not the amount was paid to 

32 

that person. 

33 

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56B  Notice of decision that document etc. produced substantiates 

that amount paid should have been paid 

Amount paid substantiated 

 

(1)  If: 

 

(a)  a person produces to the Chief Executive Medicare, or to a 

Human Services employee, a document, extract or copy 

relating to a dental service after being requested, or required 

under section 32C, to do so; and 

 

(b)  the Chief Executive Medicare decides that the information 

contained in the document, extract or copy properly 

10 

substantiates that the amount paid, by way of dental benefit, 

11 

in respect of the service, should have been paid; 

12 

the Chief Executive Medicare must give the person written notice 

13 

of the decision. 

14 

Circumstances beyond control exist 

15 

 

(2)  If the Chief Executive Medicare is satisfied, for the purposes of 

16 

subsection 56A(2) or (4), that circumstances beyond a person's 

17 

control exist, the Chief Executive Medicare must give the person 

18 

written notice of the decision. 

19 

 

(3)  If the Chief Executive Medicare is satisfied, for the purposes of 

20 

subsection 56A(6), that circumstances exist beyond the control of: 

21 

 

(a)  the person from whom the amount concerned is recoverable; 

22 

and 

23 

 

(b)  the recipient of the notice concerned; 

24 

the Chief Executive Medicare must give written notice of the 

25 

decision to the person from whom the amount concerned is 

26 

recoverable. 

27 

Notice may include notice of other decisions 

28 

 

(4)  The Chief Executive Medicare's written notice to a person of a 

29 

decision may include written notice of other decisions referred to 

30 

in this section, or section 56C, that also are required to be given to 

31 

the person. 

32 

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56C  Notice of decision to claim amount as debt 

 

(1)  If an amount is recoverable under subsection 56(2), or 56A(1), (3) 

or (5), as a debt due to the Commonwealth from a person, or from 

an estate, the Chief Executive Medicare must give written notice to 

the person or estate of: 

 

(a)  the decision to claim the amount as a debt; and 

 

(b)  the reasons for the decision; and 

 

(c)  the right of the person or estate to seek review of the decision 

under subsection 56D(1). 

 

(2)  The written notice may also include notice of other decisions 

10 

referred to in this section, or section 56B, that also are required to 

11 

be given to the person or estate. The notice may also, as 

12 

appropriate, state that the Chief Executive Medicare was not 

13 

satisfied, for the purposes of subsection 56A(2), (4) or (6), that 

14 

circumstances beyond a person's control existed. 

15 

 

(3)  A failure to comply with the requirements of subsection (1) does 

16 

not affect the validity of the decision. 

17 

 

(4)  The Chief Executive Medicare must not serve a notice on a person 

18 

or an estate claiming an amount as a debt before the end of the 

19 

period of 28 days after written notice of the decision referred to in 

20 

subsection (1) is given to the person or estate. 

21 

56D  Review of decision to claim amounts as debt 

22 

 

(1)  If the Chief Executive Medicare makes a decision referred to in 

23 

subsection 56C(1) about a person or an estate, the person or estate 

24 

may apply in writing to the Chief Executive Medicare, in the form 

25 

approved in writing by the Chief Executive Medicare, for a review 

26 

of the decision. 

27 

 

(2)  In making an application under subsection (1), the person or estate 

28 

may provide the Chief Executive Medicare with additional 

29 

information to substantiate (wholly or partly) that the amount paid, 

30 

purportedly by way of dental benefit in respect of the service, 

31 

should have been paid. 

32 

 

(3)  An application for review of a decision must be made within 28 

33 

days after the person or estate is notified of the decision. 

34 

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(4)  On receiving an application for review of a decision, the Chief 

Executive Medicare must: 

 

(a)  review the decision; and 

 

(b)  confirm, vary or revoke the decision. 

 

(5)  The Chief Executive Medicare must give to the applicant written 

notice of the decision on the review within 28 days after receiving 

the application for review. 

 

(6)  To avoid doubt, a decision referred to in subsection 56C(1) 

(including such a decision varied under this section) may be 

reviewed under this section once only. 

10 

38  Section 57 (heading) 

11 

Repeal the heading, substitute: 

12 

57  Interest payable on recoverable amounts 

13 

39  Subsection 57(1) 

14 

After "section 56", insert "or 56A". 

15 

40  Section 58 (heading) 

16 

Repeal the heading, substitute: 

17 

58  Recovering amounts by reducing future payments 

18 

41  Subsections 58(1) and (2) 

19 

Repeal the subsections, substitute: 

20 

 

(1)  The Chief Executive Medicare may reduce one or more amounts of 

21 

dental benefit payable to a person if: 

22 

 

(a)  the following conditions are satisfied: 

23 

 

(i)  an amount or amounts have previously been paid under 

24 

this Act to the person purportedly by way of dental 

25 

benefit; 

26 

 

(ii)  the amount or amounts referred to in subparagraph (i) 

27 

exceed the amount (if any) that should have been paid to 

28 

the person (whether or not the excess is recoverable as 

29 

mentioned in paragraph (b)); or 

30 

Amendments  Schedule 1 

Compliance  Part 3 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

29 

 

 

(b)  an amount is recoverable from the person under section 56 or 

56A. 

 

(2)  The reduction limit is the excess referred to in 

subparagraph (1)(a)(ii), or the amount referred to in 

paragraph (1)(b), as the case requires. 

42  Subsection 58(3) 

Omit "overpayment amount", substitute "reduction limit". 

43  Paragraph 58(4)(b) 

After "section 56", insert "or 56A". 

44  Subsection 58(4) 

10 

Omit "overpayment amount", substitute "reduction limit". 

11 

45  At the end of Division 4 of Part 6 

12 

Add: 

13 

58A  Amounts recoverable once only 

14 

 

  To avoid doubt, an amount paid purportedly by way of dental 

15 

benefit is recoverable under this Division once only. 

16 

46  Application of amendments 

17 

The amendments made by this Part apply in relation to amounts paid, 

18 

purportedly by way of dental benefits, whether before or after the 

19 

commencement of the amendments. 

20 

Schedule 1  Amendments 

Part 4  Delegation of Ministerial powers 

 

 

30 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

Part 4

--Delegation of Ministerial powers 

Dental Benefits Act 2008 

47  Section 63 

Omit: 

 

(c) 

the delegation of the Secretary's functions or powers 

under this Act; and 

substitute: 

 

(c) 

the delegation of the functions and powers of the 

Minister or the Secretary under this Act; and 

48  Before subsection 66(1) 

10 

Insert: 

11 

Delegation by Minister 

12 

 

(1A)  The Minister may, by writing, delegate any or all of his or her 

13 

functions or powers under this Act to: 

14 

 

(a)  the Secretary; or 

15 

 

(b)  an SES employee, or acting SES employee, in the 

16 

Department. 

17 

Note: 

The expressions SES employee and acting SES employee are defined 

18 

in section 2B of the Acts Interpretation Act 1901

19 

 

(1B)  In exercising powers or performing functions delegated under 

20 

subsection (1A), the delegate must comply with any directions of 

21 

the Minister. 

22 

Delegation by Secretary 

23 

Amendments  Schedule 1 

Dental providers  Part 5 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

31 

 

Part 5

--Dental providers 

Dental Benefits Act 2008 

49  Paragraph 6(1)(a) 

Repeal the paragraph, substitute: 

 

(a)  a dental practitioner who has general registration, or 

specialist registration, in the dentists division of the dental 

profession under a law of a State or Territory; 

Schedule 1  Amendments 

Part 6  Provision of information 

 

 

32 

Dental Benefits Legislation Amendment Bill 2014 

No.      , 2014 

 

Part 6

--Provision of information 

Dental Benefits Act 2008 

50  At the end of paragraph 41(1)(c) 

Add: 

 

(vi)  the Veterans' Entitlements Act 1986; or 

Amendments  Schedule 1 

Technical amendment  Part 7 

 

 

No.      , 2014 

Dental Benefits Legislation Amendment Bill 2014 

33 

 

Part 7

--Technical amendment 

Dental Benefits Act 2008 

51  Section 4 (paragraph (b) of the definition of this Act

Omit "Services", substitute "Benefits". 

 


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