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This is a Bill, not an Act. For current law, see the Acts databases.
HEALTH INSURANCE AMENDMENT (COMPLIANCE) BILL 2010
2010
The Parliament of the
Commonwealth of Australia
HOUSE OF REPRESENTATIVES
Presented and read a first time
Health Insurance Amendment
(Compliance) Bill 2010
No. , 2010
(Health and Ageing)
A Bill for an Act to amend the Health Insurance Act
1973, and for related purposes
i Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
Contents
1 Short
title
...........................................................................................
1
2 Commencement
.................................................................................
1
3 Schedule(s)
........................................................................................
1
Schedule 1--Amendment of the Health Insurance Act 1973
3
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 1
A Bill for an Act to amend the Health Insurance Act
1
1973, and for related purposes
2
The Parliament of Australia enacts:
3
1 Short title
4
This Act may be cited as the Health Insurance Amendment
5
(Compliance) Act 2010.
6
2 Commencement
7
This Act commences on the day after this Act receives the Royal
8
Assent.
9
3 Schedule(s)
10
Each Act that is specified in a Schedule to this Act is amended or
11
repealed as set out in the applicable items in the Schedule
12
2 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
concerned, and any other item in a Schedule to this Act has effect
1
according to its terms.
2
3
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 3
Schedule 1--Amendment of the Health
1
Insurance Act 1973
2
3
1 Subsection 3(1)
4
Insert:
5
medicare number has the same meaning as in subsection 84(1) of
6
the National Health Act 1953.
7
2 After section 129AAC
8
Insert:
9
129AAD Notice to produce documents
10
When section applies
11
(1) This section applies if the Medicare Australia CEO:
12
(a) has a reasonable concern that an amount paid, purportedly by
13
way of benefit or payment under this Act, in respect of one or
14
more professional services, may exceed the amount (if any)
15
that should have been paid; and
16
(b) has taken into account advice given to him or her by a
17
medical practitioner who is an employee of Medicare
18
Australia about the types of documents that contain
19
information relevant to ascertaining whether amounts paid in
20
respect of professional services of the same kind or kinds as
21
the service or services referred to in paragraph (a) should
22
have been paid; and
23
(c) has taken reasonable steps to consult with a relevant
24
professional body about the types of documents that contain
25
information relevant to ascertaining whether amounts paid in
26
respect of professional services of the same kind or kinds as
27
the service or services referred to in paragraph (a) should
28
have been paid.
29
Note:
For the purposes of paragraph (a), the CEO may, for example, have a
30
reasonable concern about benefits or payments made in respect of:
31
(a) professional services rendered by individual practitioners; or
32
(b) professional
services
rendered by particular kinds of
33
practitioners; or
34
Schedule 1 Amendment of the Health Insurance Act 1973
4 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
(c) the rendering of services to which specific items, or groups of
1
items, relate.
2
CEO may require person to produce document etc.
3
(2) If the CEO believes on reasonable grounds that:
4
(a)
a
person:
5
(i) who rendered a professional service in respect of which
6
an amount has been paid that is the subject of the CEO's
7
concern; or
8
(ii) on whose behalf such a professional service was
9
rendered; or
10
(b) subject to subsection (7), another person;
11
has possession, custody or control of one or more documents
12
relevant to ascertaining whether the amount paid in respect of the
13
professional service should have been paid, the CEO may, by
14
written notice given to the person, require the person to do any or
15
all of the things mentioned in subsection (5).
16
(3) The CEO may only give a notice to a person under subsection (2)
17
in respect of a professional service if the CEO has given the person
18
a reasonable opportunity to respond to a written request (other than
19
under this section) to produce to the CEO, or an employee of
20
Medicare Australia, documents relevant to ascertaining whether the
21
amount paid, purportedly by way of benefit or payment under this
22
Act, in respect of the service, should have been paid.
23
(4) A notice may only be given in respect of a professional service that
24
was rendered in the period of 2 years immediately before the notice
25
is given.
26
(5) The CEO may require the person, in relation to each professional
27
service specified in the notice:
28
(a) subject to subsection (6), to produce to the CEO, or an
29
employee of Medicare Australia, any document, or extract of
30
any document, that is relevant for the purpose set out in
31
subsection (2); or
32
(b) to make a copy of any such document or extract and to
33
produce that copy to the CEO or employee.
34
Note:
For a person referred to in paragraph (2)(a), failure to comply with a
35
notice may lead to recovery action (see section 129AC) and an
36
administrative penalty may be applied (see sections 129AEA,
37
129AEB and 129AEC). For a person referred to in paragraph (2)(b),
38
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 5
failure to comply with a notice may lead to a civil penalty (see
1
section 129AAE).
2
(6) If a document, extract or copy contains clinical details relating to
3
an individual, the person to whom the notice is given is not
4
required to produce the document, extract or copy to a person other
5
than an employee of Medicare Australia who is a medical
6
practitioner.
7
CEO not to give notice to certain persons
8
(7) A person referred to in paragraph (2)(b) does not include:
9
(a) the person in respect of whom the professional service was
10
rendered; or
11
(b) the person who incurred the medical expenses in respect of
12
the service.
13
Content of notice
14
(8) The notice must:
15
(a) specify details of each professional service (including the
16
item, date on which the service was rendered and medicare
17
number of the person in respect of whom the service was
18
rendered) in relation to which the document, extract or copy
19
is to be produced; and
20
(b) specify the reason or reasons for the CEO's concern that an
21
amount paid, purportedly by way of benefit or payment under
22
this Act, in respect of each such service may exceed the
23
amount (if any) that should have been paid; and
24
(c) specify the information relevant to ascertaining whether
25
amounts paid in respect of each such service should have
26
been paid; and
27
(d) specify how the document, extract or copy is to be produced;
28
and
29
(e) contain a statement to the effect that the person to whom the
30
notice is given is not expected to produce a document, extract
31
or copy containing clinical details relating to an individual
32
unless the document, extract or copy is necessary to
33
ascertaining whether the amount paid in respect of the service
34
should have been paid; and
35
(f) specify the period within which, and place at which, the
36
document, extract or copy is to be produced.
37
Schedule 1 Amendment of the Health Insurance Act 1973
6 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
The period specified under paragraph (f) must be a period ending
1
at least 21 days after the day on which the notice is given.
2
Note:
For the purpose of paragraphs (8)(b) and (c) the notice will include the
3
reason for the CEO's concern about the payment and explain the
4
factual issue that the person is required to substantiate.
5
Health information
6
(9) The power under this section to require a document, extract or
7
copy to be produced includes the power to require the production
8
of a document, extract or copy containing health information
9
(within the meaning of the Privacy Act 1988) about an individual.
10
Clinical relevance of particular professional service not to be
11
taken into account
12
(10) In forming a reasonable concern for the purposes of subsection (1),
13
the CEO is not to take into account the clinical relevance of a
14
particular professional service.
15
Section not limited
16
(11) This section is not limited by:
17
(a) any other provision of this Act; or
18
(b) any provision of the Medicare Australia Act 1973 or any
19
other Act;
20
that relates to the powers of the CEO to require the production of
21
documents.
22
Definition
23
(12) In this section:
24
relevant professional body means a body declared by the Minister
25
under subsection (13) to be a relevant professional body.
26
(13) The Minister may, by legislative instrument, declare a body to be a
27
relevant professional body for the purposes of this section.
28
129AAE Civil penalty--failure to comply with requirement in notice
29
(1) A person referred to in paragraph 129AAD(2)(b) contravenes this
30
section if:
31
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 7
(a) the person is given a notice under section 129AAD requiring
1
the person to do something in respect of a professional
2
service; and
3
(b) the person fails to comply with the requirement within the
4
period specified in the notice.
5
Civil penalty:
6
(a) for an individual--20 penalty units; and
7
(b) for a body corporate--100 penalty units.
8
(2) It is a defence in proceedings for a contravention of subsection (1)
9
if:
10
(a) the failure to comply is brought about by another person over
11
whom the person has no control or by a non-human act or
12
event over which the person has no control; and
13
(b) the person could not reasonably be expected to guard against
14
the failure.
15
Note:
The defendant bears the onus of proving the matters necessary to
16
establish the defence.
17
129AAF Self-incrimination etc.
18
(1) A person is not excused from producing a document, extract or
19
copy when required to do so under section 129AAD on the ground
20
that doing so would tend to incriminate the person or expose the
21
person to a penalty.
22
(2) However, the production of the document, extract or copy, and any
23
information obtained as a direct or indirect result of the production
24
of the document, extract or copy, are not admissible in evidence
25
against the person in:
26
(a) any criminal proceedings, other than:
27
(i) proceedings for an offence against this Act dealing with
28
false or misleading information or documents; and
29
(ii) proceedings for an offence against section 137.1 or
30
137.2 of the Criminal Code (which deals with false or
31
misleading information or documents) that relates to
32
this Act; or
33
(b) any civil proceedings, other than a civil proceeding arising
34
under Part VIA or this Part.
35
Schedule 1 Amendment of the Health Insurance Act 1973
8 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
129AAG CEO or employee of Medicare Australia may deal with
1
documents etc. produced
2
(1) If a document, extract or copy has been produced under
3
section 129AAD in respect of a professional service, the Medicare
4
Australia CEO, or an employee of Medicare Australia, may do all
5
or any of the things mentioned in subsection (2) for the purpose of
6
ascertaining whether the information contained in the document,
7
extract or copy properly substantiates that an amount paid,
8
purportedly by way of benefit or payment under this Act, in respect
9
of the service, should have been paid.
10
Note:
If the information does not properly substantiate the amount, recovery
11
action may be taken (see section 129AC) and an administrative
12
penalty may be applied (see sections 129AEA, 129AEB and
13
129AEC).
14
(2) The CEO or employee may:
15
(a) inspect the document, extract or copy; and
16
(b) make a copy of, or take an extract from, the document,
17
extract or copy; and
18
(c) retain the document, extract or copy in his or her possession
19
for such reasonable period as he or she thinks fit.
20
(3) The person otherwise entitled to possession of the document or
21
extract is entitled to be supplied, as soon as practicable, with a
22
copy certified by the CEO, or an employee, to be a true copy.
23
(4) The certified copy must be received in all courts and tribunals as
24
evidence as if it were the original.
25
(5) Until a certified copy is supplied, the CEO, or an employee, must,
26
at such times and places as he or she thinks appropriate, permit the
27
person otherwise entitled to possession of the document or extract,
28
or a person authorised by that person, to inspect and make copies
29
of, or take extracts from, the document or extract.
30
(6) This section is not limited by:
31
(a) any other provision of this Act; or
32
(b) any provision of the Medicare Australia Act 1973 or any
33
other Act;
34
that relates to the powers of the CEO, or an employee of Medicare
35
Australia, to deal with a document, extract or copy as described in
36
subsection (2) of this section.
37
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 9
(7) An employee of Medicare Australia referred to in this section may
1
be an employee other than the employee to whom the document,
2
extract or copy was required to be produced.
3
129AAH Notice of decision: no amount recoverable because
4
amounts paid substantiated etc.
5
Amount paid substantiated
6
(1)
If:
7
(a) a person produces to the Medicare Australia CEO, or to an
8
employee of Medicare Australia, a document, extract or copy
9
relating to a professional service after being requested, or
10
required under section 129AAD, to do so; and
11
(b) the CEO decides that the information contained in the
12
document, extract or copy properly substantiates that the
13
amount paid, by way of benefit or payment under this Act, in
14
respect of the service, should have been paid;
15
the CEO must give the person written notice of the decision.
16
Circumstances beyond control exist
17
(2) If the CEO is satisfied, for the purposes of subsection 129AC(1B)
18
or (1D), that circumstances beyond a person's control exist, the
19
CEO must give the person written notice of the decision.
20
(3) If the CEO is satisfied, for the purposes of subsection 129AC(1F),
21
that circumstances exist beyond the control of:
22
(a) the person from whom the amount concerned is recoverable;
23
and
24
(b) the recipient of the notice concerned;
25
the CEO must give written notice of the decision to the person
26
from whom the amount concerned is recoverable.
27
Notice may include notice of other decisions
28
(4) The CEO's written notice to a person of a decision may include
29
written notice of other decisions referred to in this section, or
30
section 129AAI, that also are required to be given to the person.
31
Schedule 1 Amendment of the Health Insurance Act 1973
10 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
129AAI Notice of decision: amounts recoverable
1
(1) If an amount is recoverable under subsection 129AC(1), (1A), (1C)
2
or (1E) as a debt due to the Commonwealth from a person, or from
3
an estate, the Medicare Australia CEO must give written notice to
4
the person or estate of:
5
(a) the decision to claim the amount as a debt; and
6
(b) the reasons for the decision; and
7
(c) the right of the person or estate to seek review of the decision
8
under subsection 129AAJ(1).
9
(2) The CEO's written notice to a person or an estate of a decision
10
may include written notice of other decisions referred to in this
11
section, or section 129AAH, that also are required to be given to
12
the person or estate. The written notice may also, as appropriate,
13
state that the CEO was not satisfied, for the purposes of subsection
14
129AC(1B), (1D) or (1F), that circumstances beyond a person's
15
control existed.
16
(3) A failure to comply with the requirements of subsection (1) does
17
not affect the validity of the decision.
18
(4) The CEO must not serve a notice on a person or an estate claiming
19
an amount as a debt before the end of the period of 28 days after
20
written notice of the decision referred to in subsection (1) is given
21
to the person or estate.
22
129AAJ Review of decisions to claim amounts as debts
23
(1) If the Medicare Australia CEO makes a decision referred to in
24
subsection 129AAI(1) about a person or an estate, the person or
25
estate may apply in writing to the CEO, in the form approved in
26
writing by the CEO, for a review of the decision.
27
(2) In making an application under subsection (1), the person or estate
28
may provide the Medicare Australia CEO with additional
29
information to substantiate (wholly or partly) that the amount paid,
30
purportedly by way of benefit or payment under this Act in respect
31
of the service, 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
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 11
(4) On receiving an application for review of a decision, the CEO
1
must:
2
(a) review the decision; and
3
(b) confirm, vary or revoke the decision.
4
(5) The CEO must give to the applicant written notice of the decision
5
on the review within 28 days after receiving the application for
6
review.
7
(6) To avoid doubt, a decision referred to in subsection 129AAI(1)
8
(including such a decision varied under this section) may be
9
reviewed under this section once only.
10
3 Application
11
Sections 129AAD, 129AAH and 129AAI of the Health Insurance Act
12
1973 apply in respect of a professional service that is rendered on or
13
after the commencement of those sections.
14
4 After subsection 129AC(1)
15
Insert:
16
Failure to produce document
17
(1A) Subject to subsection (1B), if:
18
(a) a person referred to in paragraph 129AAD(2)(a) is required,
19
by a notice given under section 129AAD, to produce a
20
document, extract or copy in respect of a professional
21
service; and
22
(b) the person does not comply with the requirement within the
23
period set out in the notice;
24
the amount paid, purportedly by way of benefit or payment under
25
this Act, in respect of the service, is recoverable as a debt due to
26
the Commonwealth from the person, or the estate of the person,
27
whether or not the amount was paid to the person.
28
(1B) Subsection (1A) does not apply if the person concerned satisfies
29
the Medicare Australia CEO that the person's non-compliance is
30
due to circumstances beyond the person's control.
31
Note:
See section 129AAJ for review of decisions.
32
Schedule 1 Amendment of the Health Insurance Act 1973
12 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
Amount not properly substantiated--notice to person referred to in
1
paragraph 129AAD(2)(a)
2
(1C) Subject to subsection (1D), if:
3
(a) a person referred to in paragraph 129AAD(2)(a) is required,
4
by a notice given under section 129AAD, to produce a
5
document, extract or copy in respect of a professional
6
service; and
7
(b) the person complies with the requirement within the period
8
set out in the notice; and
9
(c) the information contained in the document, extract or copy
10
does not properly substantiate (wholly or partly) that the
11
amount paid, purportedly by way of benefit or payment under
12
this Act, in respect of the service, should have been paid;
13
then, to the extent that the amount is not properly substantiated, the
14
amount is recoverable as a debt due to the Commonwealth from
15
the person, or the estate of the person, whether or not the amount
16
was paid to the person.
17
(1D) Subsection (1C) does not apply if the person concerned satisfies
18
the Medicare Australia CEO that the reason that the information
19
contained in the document, extract or copy does not properly
20
substantiate the amount is due to circumstances beyond the
21
person's control.
22
Note:
See section 129AAJ for review of decisions.
23
Amount not properly substantiated--notice to person referred to in
24
paragraph 129AAD(2)(b)
25
(1E) Subject to subsection (1F), if:
26
(a) a person (the notice recipient) referred to in paragraph
27
129AAD(2)(b) is required, by a notice given under
28
section 129AAD, to produce a document, extract or copy in
29
respect of a professional service; and
30
(b) the notice recipient complies with the requirement within the
31
period set out in the notice; and
32
(c) the information contained in the document, extract or copy
33
does not properly substantiate (wholly or partly) that the
34
amount paid, purportedly by way of benefit or payment under
35
this Act, in respect of the service, should have been paid;
36
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 13
then, to the extent that the amount is not properly substantiated, the
1
amount is recoverable as a debt due to the Commonwealth from:
2
(d) the person who rendered the service, or on whose behalf the
3
service was rendered; or
4
(e) the estate of that person;
5
whether or not the amount was paid to that person.
6
(1F) Subsection (1E) does not apply if the person from whom the
7
amount concerned is recoverable satisfies the Medicare Australia
8
CEO that the reason that the information contained in the
9
document, extract or copy does not properly substantiate the
10
amount is due to circumstances beyond the control of the person
11
and the notice recipient.
12
Note:
See section 129AAJ for review of decisions.
13
Administrative penalty
14
(1G)
If:
15
(a) a person is given a notice under section 129AEC of the
16
person's liability to pay an administrative penalty; and
17
(b) the person does not pay the penalty by the day set out in the
18
notice as the day by which the penalty becomes due for
19
payment;
20
the amount set out in the notice is recoverable as a debt due to the
21
Commonwealth from the person or the estate of the person.
22
Recovery once only
23
(1H) To avoid doubt, an amount paid purportedly by way of benefit or
24
payment under this Act is recoverable under this section once only.
25
Note 1: The heading to section 129AC is replaced by the heading "Recovery of amounts
26
overpaid etc. and administrative penalties".
27
Note 2: The following heading to subsection 129AC(1) is inserted "False or misleading
28
statements".
29
5 At the end of paragraph 129AC(2)(a)
30
Add ", (1A), (1C), (1E) or (1G)".
31
Note:
The following heading to subsection 129AC(2) is inserted "Interest on amounts".
32
6 At the end of paragraph 129AC(2)(a)
33
Add "and".
34
Schedule 1 Amendment of the Health Insurance Act 1973
14 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
7 Subsection 129AC(4)
1
Repeal the subsection, substitute:
2
Set-off
3
(4) Despite any other provision of this Act, if:
4
(a) an amount (the recoverable amount) is recoverable from a
5
person under subsection (1), (1A), (1C), (1E) or (1G); and
6
(b) an amount (the later amount) of benefit or payment later
7
becomes payable to the person under this Act; and
8
(c) the person so agrees;
9
the Medicare Australia CEO may, on behalf of the
10
Commonwealth, set off all or a part of the recoverable amount
11
against all or a part of the later amount.
12
8 Application and saving
13
(1)
Subsection 129AC(4) of the Health Insurance Act 1973 as amended by
14
this Act applies in relation to amounts recoverable under subsection
15
129AC(1) of that Act before, on or after the commencement of this
16
item.
17
(2)
If a person's agreement referred to in subsection 129AC(4) of the
18
Health Insurance Act 1973 is in force, in relation to an amount,
19
immediately before the commencement of this item, that agreement is
20
taken to be in force for the purposes of:
21
(a) that amount; and
22
(b) that subsection as in force immediately after that
23
commencement.
24
(3)
Subitem (2) does not prevent the person withdrawing the agreement.
25
9 After section 129AE
26
Insert:
27
129AEA Liability for administrative penalty
28
Subsection 129AC(1) applies
29
(1) A person is liable for an administrative penalty in respect of a
30
professional service rendered by, or on behalf of, the person if:
31
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 15
(a) the Medicare Australia CEO has served a notice on the
1
person claiming an amount (the total amount) as a debt due
2
to the Commonwealth under subsection 129AC(1); and
3
(b) the total amount consists of, or includes, an amount (the
4
recoverable amount) in respect of the service; and
5
(c) no part of the total amount became due more than 2 years
6
before the notice was served; and
7
(d) the total amount is more than:
8
(i)
$2,500;
or
9
(ii) if a higher amount is prescribed by the regulations--that
10
higher amount.
11
Subsection 129AC(1A) or (1C) applies
12
(2) A person is liable for an administrative penalty in respect of a
13
particular professional service if:
14
(a) a notice was given to the person under section 129AAD
15
requiring the person to produce a document, extract or copy
16
relevant to the particular professional service; and
17
(b) subsection 129AC(1A) or (1C) applies in respect of the
18
person and the particular professional service; and
19
(c) if the notice specifies one or more other professional
20
services--either or both of subsections 129AC(1A) and (1C)
21
apply in respect of the person and any other professional
22
service specified in the notice; and
23
(d) the sum of the amounts that may be recovered from the
24
person under those subsections in respect of the particular
25
professional service, and any other professional service
26
specified in the notice, is more than:
27
(i)
$2,500;
or
28
(ii) if a higher amount is prescribed by the regulations--that
29
higher amount; and
30
(e) the Medicare Australia CEO has served a notice on the
31
person claiming as a debt due to the Commonwealth the
32
amount (the recoverable amount) that may be recovered
33
from the person under whichever of subsection 129AC(1A)
34
or (1C) applies in respect of the person and the particular
35
professional service.
36
Schedule 1 Amendment of the Health Insurance Act 1973
16 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
Subsection 129AC(1E) applies
1
(3) A person (the practitioner) who rendered a particular professional
2
service, or on whose behalf a particular professional service was
3
rendered, is liable for an administrative penalty in respect of the
4
service if:
5
(a) a notice was given to another person under section 129AAD
6
requiring the person to produce a document, extract or copy
7
relevant to the particular professional service; and
8
(b) subsection 129AC(1E) applies in respect of the practitioner
9
and the particular professional service; and
10
(c) if the notice specifies one or more other professional
11
services--subsection 129AC(1E) applies in respect of the
12
practitioner and any other professional service specified in
13
the notice; and
14
(d) the sum of the amounts that may be recovered from the
15
practitioner under that subsection in respect of the particular
16
professional service, and any other professional service
17
specified in the notice, is more than:
18
(i)
$2,500;
or
19
(ii) if a higher amount is prescribed by the regulations--that
20
higher amount; and
21
(e) the Medicare Australia CEO has served a notice on the
22
practitioner claiming as a debt due to the Commonwealth the
23
amount (the recoverable amount) that may be recovered
24
from the practitioner under subsection 129AC(1E) in respect
25
of the particular professional service.
26
129AEB Amount of administrative penalty
27
(1) The amount of the administrative penalty in respect of a
28
professional service is worked out in accordance with this section.
29
Base penalty amount
30
(2) Subject to subsections (3), (4), (5) and (6), the amount (the base
31
penalty amount) of the administrative penalty is 20% of whichever
32
of the following applies in respect of the professional service:
33
(a) the recoverable amount referred to in paragraph
34
129AEA(1)(b);
35
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 17
(b) the recoverable amount referred to in paragraph
1
129AEA(2)(e);
2
(c) the recoverable amount referred to in paragraph
3
129AEA(3)(e).
4
Reductions in base penalty amount
5
(3) A person's base penalty amount for a professional service is
6
reduced in accordance with the table.
7
Reductions in base penalty amount
Item
If...
the base penalty
amount is reduced
by...
1
before the Medicare Australia CEO contacts the
person (whether by notice under section 129AAD
or otherwise) about the professional service, the
person voluntarily tells the CEO, or an employee
of Medicare Australia, in the form approved in
writing by the CEO, that an amount paid,
purportedly by way of benefit or payment under
this Act, in respect of the service exceeds the
amount (if any) that should have been paid
100%
2
(a) after the Medicare Australia CEO contacts the
person about the service; and
(b) before the CEO gives a notice to the person
under section 129AAD that specifies the
service;
the person voluntarily tells the CEO, or an
employee of Medicare Australia, in the form
approved in writing by the CEO, that an amount
paid, purportedly by way of benefit or payment
under this Act, in respect of the service exceeds the
amount (if any) that should have been paid
50%
3
(a) after the Medicare Australia CEO gives a notice
to the person under section 129AAD that
specifies the service; and
(b) before the end of the period specified in the
notice;
the person tells the CEO, or an employee of
Medicare Australia, in the form approved in
writing by the CEO, that an amount paid,
purportedly by way of benefit or payment under
25%
Schedule 1 Amendment of the Health Insurance Act 1973
18 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
Reductions in base penalty amount
Item
If...
the base penalty
amount is reduced
by...
this Act, in respect of the service exceeds the
amount (if any) that should have been paid
Increases in base penalty amount
1
(4) A person's base penalty amount for a professional service is
2
increased by 25% if:
3
(a) the Medicare Australia CEO gives a notice to the person
4
under section 129AAD that specifies the service; and
5
(b) the person does not comply with the notice in respect of the
6
service, or any other professional service specified in the
7
notice, within the period specified in the notice.
8
(5) A person's (the practitioner's) base penalty amount for a
9
professional service (the latest professional service) rendered by,
10
or on behalf of, the practitioner is increased by 50% if:
11
(a) any of the following apply:
12
(i) the Medicare Australia CEO gives a notice to the
13
practitioner under section 129AAD that specifies the
14
latest professional service;
15
(ii) the CEO serves a notice on the practitioner claiming an
16
amount as a debt due to the Commonwealth under
17
subsection 129AC(1) and that amount consists of, or
18
includes, an amount in respect of the latest professional
19
service;
20
(iii) the CEO gives a notice to another person under
21
section 129AAD that specifies the latest professional
22
service; and
23
(b) any of the following apply:
24
(i) in the 24 months immediately before the notice is given
25
or served, the CEO has given to the practitioner one or
26
more other notices under section 129AAD specifying
27
other professional services rendered by, or on behalf of,
28
the practitioner;
29
(ii) in the 24 months immediately before the notice is given
30
or served, the CEO has served on the practitioner one or
31
Amendment of the Health Insurance Act 1973 Schedule 1
Health Insurance Amendment (Compliance) Bill 2010 No. , 2010 19
more other notices claiming an amount as a debt due to
1
the Commonwealth under subsection 129AC(1)
2
consisting of, or including, other professional services
3
rendered by, or on behalf of, the practitioner;
4
(iii) in the 24 months immediately before the notice is given
5
or served, the CEO has given to another person one or
6
more other notices under section 129AAD specifying
7
other professional services that were rendered by, or on
8
behalf of, the practitioner; and
9
(c) the total of:
10
(i) the sum of the recoverable amounts (see subsection (2))
11
in respect of each other professional service; and
12
(ii) the sum of the base penalty amounts for each other
13
professional service as reduced or increased in
14
accordance with this section (if relevant);
15
is more than:
16
(iii)
$30,000;
or
17
(iv) if a higher amount is prescribed by the regulations--that
18
higher amount.
19
(6) If both subsections (4) and (5) apply in relation to a professional
20
service, apply subsection (4) and then subsection (5). In applying
21
subsection (5) in that case, the base penalty amount is that amount
22
as increased under subsection (4).
23
Interaction between reduction and increase
24
(7) If a base penalty amount is subject to both a reduction and an
25
increase, apply the reduction first.
26
129AEC Notice of administrative penalty
27
The Medicare Australia CEO must give to a person who is liable
28
for an administrative penalty written notice of the following:
29
(a) the person's liability to pay an administrative penalty in
30
respect of one or more professional services;
31
(b) the professional service to which each administrative penalty
32
relates;
33
(c) if there is more than one professional service--the total of
34
the administrative penalties;
35
Schedule 1 Amendment of the Health Insurance Act 1973
20 Health Insurance Amendment (Compliance) Bill 2010 No. , 2010
(d) the day by which the penalty becomes due for payment
1
(which must be at least 14 days after the day on which the
2
notice is given);
3
(e) the fact that the notice is given under this section.
4
The notice may also deal with a debt due to the Commonwealth
5
under section 129AC arising in relation to the professional service.
6
10 Application
7
Sections 129AEA, 129AEB and 129AEC of the Health Insurance Act
8
1973 apply in respect of a professional service that is rendered on or
9
after the commencement of those sections.
10