Commonwealth Consolidated Regulations

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HUMAN SERVICES (MEDICARE) REGULATIONS 2017 - REG 28

Provision of pharmaceutical benefits

  (1)   The following are prescribed functions of the Chief Executive Medicare:

  (a)   to process claims for payment relating to the provision of pharmaceutical benefits under Part   VII of the National Health Act, and to make payments of those claims;

  (b)   to devise and implement measures to prevent or detect contraventions of Part   VII of the National Health Act or the Pharmaceutical Benefits Regulations;

  (c)   to investigate cases where there are reasonable grounds to suspect that an act in relation to the provision of a pharmaceutical benefit may constitute an offence under the National Health Act, the Pharmaceutical Benefits Regulations, the Crimes Act 1914 or the Criminal Code ;

  (d)   if an investigation under paragraph   ( c) discloses enough evidence for a prosecution--to refer the case and the evidence to the Australian Federal Police or the Director of Public Prosecutions;

  (e)   to undertake action (including starting legal proceedings) to recover from a person an amount relating to a pharmaceutical benefit that is recoverable by the Commonwealth, including under the National Health Act or the Pharmaceutical Benefits Regulations.

  (2)   The following functions of the Repatriation Commission under the Veterans' Entitlements Act 1986 and the Australian Participants in British Nuclear Tests and British Commonwealth Occupation Force (Treatment) Act 2006 are prescribed functions of the Chief Executive Medicare:

  (a)   processing claims for payment relating to the provision of pharmaceutical benefits under those Acts ;

  (b)   making payments of those claims.

  (3)   The following functions of the Military Rehabilitation and Compensation Commission under the Military Rehabilitation and Compensation Act 2004 are prescribed functions of the Chief Executive Medicare:

  (a)   processing claims for payment relating to the provision of pharmaceutical benefits under that Act ;

  (b)   making payments of those claims.

  (4)   The following functions of the Military Rehabilitation and Compensation Commission under the Safety, Rehabilitation and Compensation (Defence - related Claims) Act 1988 are prescribed functions of the Chief Executive Medicare:

  (a)   processing claims for payment relating to the provision of pharmaceutical benefits under that Act;

  (b)   making payments of those claims.


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