Statutory Rules 1985 No. 701

Health Insurance Commission Regulations2

(Amendment)

I, THE GOVERNOR-GENERAL of the Commonwealth of Australia, acting with the advice of the Federal Executive Council, hereby make the following Regulations under the Health Insurance Commission Act 1973.

Dated 16 May 1985.

N. M. STEPHEN

Governor-General

By His Excellency’s Command,

Neal Blewett

Minister of State for Health

Commencement

1. These Regulations shall come into operation on 20 May 1985.

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;

S.R. 136/85 Cat. No.  —Recommended retail price 40c.                10/14/5/1985

‘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), 19 d (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.”.

NOTES

1. Notified in the Commonwealth of Australia Gazette on 20 May 1985.

2. Statutory Rules 1975 No. 27 as amended to date. For previous amendments see Note 2 to Statutory Rules 1985 No. 41 and see also Statutory Rules 1985 No. 41.

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