Purpose and
Structure of the Bill
The Health
Legislation Amendment (Medicare Compliance and Other Measures) Bill 2021 (the
Bill) amends the Health
Insurance Act 1973 (HIA), the Dental Benefits Act
2008 (DBA), and the National Health Act
1953 (NHA) to make a number of changes to the Commonwealth’s health
provider compliance program.
The Bill is comprised of one Schedule which is divided
into four Parts:
- Part
1 amends the HIA to provide for a number of amendments to the operation
of the Professional Services Review (PSR) Scheme, including allowing the
Director of PSR to enter into agreements with body corporates
- Part
2 amends the HIA, NHA and DBA to clarify that a person or
body corporate owing a debt to the Commonwealth may only make one application
to the Administrative Appeals Tribunal with respect to a reconsidered
decision/notice of assessment/shared debt determination even where multiple
garnishee notices have been issued in relation to the debt;
- Part
3 makes a number of amendments to the HIA, NHA and DBA to clarify
the Commonwealth’s debt recovery arrangements following the passage of the Health Legislation
Amendment (Improved Medicare Compliance and Other Measures) Act 2018;
and
- Part
4 amends the NHA and DBA respectively to replace references in
those Acts to ‘making a false or misleading statement’ with references to the
‘giving of false or misleading information’.
Background
The HIA, NHA and DBA set out a
legislative framework for the provision and claiming of services and benefits
with respect to the three major public health funding schemes: the Medicare Benefits
Schedule (MBS), the Pharmaceutical Benefits Scheme (PBS) and the Child Dental
Benefits Scheme (CDBS).
In the 2018–19 financial year, the combined expenditure of
the three health schemes and the Practice Incentive Program (PIP) was $36.6
billion (which is estimated to have grown to over $42.6 billion in 2020-21),[1]
representing about half of all Australian government expenditure on health.[2]
The 2018–19 expenditure for the relevant public health funding schemes and the
PIP is set out at Table 1 below.
Table 1: Department of Health:
health funding schemes and incentive programs
| Scheme/program |
Purpose |
2018-2019
expenditure |
| MBS |
The MBS, established
under the HIA, is Australia’s national health insurance scheme which
subsidises the cost of selected medical services for eligible patients that
are provided by eligible practitioners. |
$24.1 billion |
| PBS |
The PBS, established
under the NHA, is part of the Australian Government’s broader National
Medicines Policy. Under the PBS, the Australian Government subsidises the
cost of medicine for most medical conditions. |
$11.8 billion |
| CDBS |
The CDBS, established
under Part VAA of the HIA and the DBA, is a Commonwealth funded
dental scheme. The scheme provides benefits for a wide range of dental
services, such as examinations, x-rays and preventive treatments to children
up to 17 years of age whose families receive certain government benefits
(eligible children). |
$352.1 million |
| PIP |
Practice Incentive
Program (PIP) payments support eligible general practices that meet specific
performance criteria designed to encourage quality care, enhanced capacity,
and improved access and health outcomes for patients. Incentive payments
include eHealth, quality improvement, teaching, Indigenous health, after
hours care, procedural activities and loadings for rural locations. |
$321.9 million |
Source: Australian National Audit Office (ANAO), Managing Health
Provider Compliance, Auditor-General Report, 17, 2020-21, ANAO,
Canberra, 23 November 2020, p. 12 and Department of Health (DoH), Health
Provider Compliance Strategy 2021–22, DoH, Canberra, July 2021, p. 1.
The relevant Acts also provide for post payment compliance
activities to be undertaken by the Government, to identify incorrect claiming
and recover debts in relations to the three schemes and the PIP.
The Provider Benefits Integrity Division (PBID) in the
Department of Health (Health) is responsible for the Commonwealth’s health
provider compliance program.[3]
Services Australia (formerly the Department of Human Services) administers the MBS,
PBS and CDBS on behalf of Health and makes payments. Health is responsible for
the legislation and policy for the schemes and enforcing compliance of provider
billing.
The Australian National Audit Office reported that in the 2018-2019
financial year, Health recovered $49.3 million in claims which should not have
been paid and reported $123.4 million in estimated savings through changes in
claiming behaviour of providers.[4]
Previous changes to debt-recovery
arrangements
In recent years, the Government has passed three Bills aimed
at improving health provider compliance arrangements:
Committee
consideration
At the time of writing, the Bill had not been referred to
any committees.
Senate Standing Committee for the
Selection of Bills
On 20 October 2021, the Senate Selection of Bills
Committee deferred consideration of the Bill to its next meeting.[8]
Senate Standing Committee for the
Scrutiny of Bills
The Senate Standing Committee for the Scrutiny of Bills has
yet to consider this Bill.[9]
Policy
position of non-government parties/independents
At the time of writing, non-government parties and
independents have not commented publicly on the Bill.
Position of
major interest groups
At the time of writing, no commentary on the Bill from
relevant stakeholders was identified.
Financial
implications
The Explanatory Memorandum states there are no financial
implications arising from the Bill.[10]
By improving debt-recovery arrangements for health
providers, the Bill may increase the amount of money which the Commonwealth can
recover and may lead to a reduction in incorrect claiming by health providers.
Statement of Compatibility with Human Rights
As required under Part 3 of the Human Rights
(Parliamentary Scrutiny) Act 2011 (Cth), the Government has assessed
the Bill’s compatibility with the human rights and freedoms recognised or
declared in the international instruments listed in section 3 of that Act.
The Government considers that to the extent there are any
limitations on human rights, these are necessary, reasonable and proportionate
to the legitimate objectives of the Bill.[11]
Potential human rights implications with respect to particular amendments are
discussed further in the ‘Key issues and provisions’ section of this Bills Digest.
Parliamentary Joint Committee on
Human Rights
The Parliamentary Joint Committee on Human Rights had no
comments with respect to this Bill.[12]
Key issues
and provisions
Part 1 - Changes
to the Professional Services Review Scheme
Part VAA of the HIA establishes the PSR Scheme. The
purpose of the PSR Scheme is to review and investigate the provision of services
by a practitioner to determine whether the practitioner has engaged in
inappropriate practice.
Subsection 81(1) of the HIA defines
‘practitioner’ to include medical practitioners, dentists, optometrists,
chiropractors, midwives, nurse practitioners, physiotherapists, podiatrists and
osteopaths. Subsection 81(1) also defines ‘service’ to mean rendering or
initiating of services under the MBS, CBDS or a relevant Department of
Veterans’ Affairs (DVA) law,[13]
or prescribing under the PBS.
Subsection 82(1) of the HIA defines ‘inappropriate
practice’ as conduct that is such that a PSR Committee could reasonably
conclude that it would be unacceptable to the general body of the members of
the profession in which the practitioner was practising when they rendered
or initiated the services. Subsection 82(2) provides that subject to
exceptional circumstances, a practitioner engages in inappropriate practice in
rendering or initiating services during a particular period (the relevant
period) if the circumstances in which some or all of the services were rendered
or initiated constitute a prescribed pattern of services.[14]
It is also an offence under paragraph 82(2)(b) for a person who is an officer
of a body corporate to knowingly, recklessly or negligently cause or permit a
practitioner employed by the person to engage in such conduct.
Section 83 of the HIA allows the Minister of Health
(the Minister) to appoint a medical practitioner to be the Director of PSR (the
Director). The Minister must not appoint a person unless the Australian Medical
Association (AMA) has agreed to the appointment.[15]
The Minister also has the power to appoint medical practitioners as Deputy Directors
of PSR and as members of the PSR Review Panel.[16]
In reviewing and investigating the provision of services
by a practitioner, PSR undertakes a three‑stage process (noting that a
review may be resolved following the first stage):
- the
first stage involves the consideration by the Director of PSR of whether a
practitioner might have engaged in inappropriate practice
- the
second stage is a peer review process by a PSR Committee (constituted under
Division 4 of Part VAA of the HIA) to determine whether the practitioner
did engage in inappropriate practice
- the
third and final stage involves the consideration and determining of an
appropriate outcome by the Determining
Authority (a statutory agency established under Division 5 of Part VAA of
the HIA).[17]
Clarification of the ability of the
CEM to refer matters to the Director of PSR
The Department of Health monitors practitioners' claiming
patterns. Under the HIA, only the Chief Executive of Medicare (CEM) may
refer cases of inappropriate practice to the Director of PSR. There is no
ability for PSR to initiate reviews of practitioners without a referral from
the CEM.
Currently, the CEM has the discretion to decide whether or
not to request the Director review the provision of services by a practitioner
unless the services rendered or initiated by the practitioner constitute a prescribed
pattern of services, in which case the CEM must refer the practitioner
to the Director.[18]
Items 3 and 4 of the Bill amend subsection
86(1) of the HIA to clarify that the CEM may only request that the Director
review the provision of services by a person where there is a possibility that
the person may have:
- provided
services during the period and
- engaged
in inappropriate practice in the provision of services.
The Explanatory Memorandum provides that these amendments
are intended to clarify ‘that there is no requirement for the CEM to undertake
an investigation to objectively determine that a particular person provided
services and/or engaged in inappropriate practice, prior to making a request to
the Director’.[19]
The proposed amendments also clarify that in reviewing the
provision of services by a person, the Director of PSR may also examine whether
the services were provided by that person or another person. The Explanatory
Memorandum notes that these changes are intended to ‘further explain’ what a
review conducted by the Director of PSR may entail,[20]
in that the PSR may access the records of health practitioners who have not
been referred to PSR in determining whether a practitioner who has been referred
is engaging in inappropriate practice.
New power for the Director of PSR
to enter into agreements with corporate entities
Upon completing a review of the provision of services by a
practitioner, the Director of PSR can decide not to take further action, enter
into an agreement with the practitioner, or refer the matter to the relevant
PSR Committee.[21]
Currently if the person under review is a practitioner,
the Director and the person may enter into a written agreement under which:
- the person acknowledges that the person engaged in
inappropriate practice in connection with rendering or initiating specified
services during the review period and
- specified action in relation to the person is to take
effect.[22]
Subsection 92(2) of the HIA specifies the kind of
actions that may be taken, including the person being reprimanded or
disqualified or having to repay the Commonwealth where a benefit has been paid
as a result of inappropriate practice. An agreement between a practitioner and
the Director of PSR does not take effect unless it is ratified by the Determining
Authority.[23]
Items 5, 7, 9, 11, 13, 14 and 18 of the Bill amend
section 92 of the HIA to allow the Director of PSR to enter into
agreements with any person, including non-practitioners and body corporates. The
Explanatory Memorandum states that these amendments will give PSR ‘the
flexibility to deal with non-practitioner persons under review in a timely and
cost-effective manner and avoid the lengthier and more resource-intensive
process of review by a PSR Committee’.[24]
Specifically, item 18 amends subsection 92(7) to
define an associated person, in relation to a person under
review, to mean:
- an employee of the person under review or
- a person otherwise engaged by the person under review
or
- an employee of a body corporate of which the person
under review is an officer or
- a person otherwise engaged by a body corporate of
which the person under review is an officer.
Item 6 repeals and replaces subsection 92(1) to allow
any person to enter into an agreement with the Director acknowledging that they
have engaged in inappropriate practice in connection with the rendering or
initiating specified services during the review period and agreeing on the
specified actions to be taken.
It does not matter whether the person rendered or initiated
the services, or they were instead rendered or initiated by an associated
person. Rather, the focus is on whether the person themselves engaged in inappropriate
practice in connection with the rendering or initiating of the service which would
include where an officer of a body corporate has allowed a practitioner under
their employ to engage in such conduct.[25]
It would also capture employees of the practitioner (for example, receptionists)
where they have caused or permitted the conduct of the practitioner which is
the subject of the review.[26]
As each referral to PSR is separate, each agreement will
only deal with the specific person/body corporate, even if the inappropriate
practice relates to services rendered or initiated by associated persons.
Further, the Explanatory Memorandum provides that ‘a body corporate’s
acknowledgement of inappropriate practice will not prejudice the position of
any individual practitioners it employs or otherwise engages’.[27]
Item 49 of the Bill provides that where a person
other than a practitioner has been referred to a PSR Committee in the 12 months
prior to the commencement of the Act, the Director of PSR may notify the
relevant Committee within six months of the Act commencing that it would be
desirable to enter into an agreement with that person.
Changes to the types of specified
actions which can be taken under an agreement
Items 8 and 10 of the Bill amend subsection
92(2) to introduce new forms of action to be agreed between the person and the
Director of PSR.
Item 8 inserts new paragraph 92(2)(aa) which
allows the Director, or a nominee of the Director, to counsel the person under
review. Counselling focuses on education for the person under review and is
intended to prevent future inappropriate practice by ensuring that the person
is aware of what is expected of them and how to correct past behaviour.[28]
Item 10 inserts new paragraph 92(2)(d) which
provides for a new action where the services the subject of the review were
rendered or initiated by as associated person, as opposed to the person under
review.
In this scenario, the agreement can require the person under
review to:
- give
specified classes of associated persons specified information about the
appropriate provision of services, that is relevant to preventing inappropriate
practice in the provision of services, in a specified form within a specified
period and
- give
the CEM evidence they have undertaken this action.
The Explanatory Memorandum states that where this
specified action is applied, the written agreement between the person under
review and the Director will specify:
- the
information to be provided
- the
classes of associated persons to which the information is to be provided
- the
form of the information to be provided (if any)
- the
time period in which the information must be provided and
- the
evidence to be provided to the CEM that the information has been provided as
specified.[29]
Item 38 of the Bill repeals subsection 106U(2) to
also allow for a draft or final determination made by the Determination
Authority with respect to a body corporate to include a direction that the
Director, or their nominee, reprimand the body corporate under review, or
counsel the body corporate under review.
Changes to the process for monitoring
a person’s compliance under their agreement with the Director
Following ratification of the agreement by the Determining
Authority, the Director must notify the CEM in writing of the making and
ratification of the agreement and ensure that any actions specified in the
agreement are taken by the person subject to the agreement.[30]
Item 15 of the Bill inserts proposed paragraph 94(4)(da)
which allows the CEM to notify the Director in writing where the CEM is of the
opinion that the person under review has not taken the required action under
the agreement, along with the CEM’s reasons for thinking that the person is
likely to be in breach of their agreement.
Item 17 inserts proposed subsection 92(4A)
which provides that before notifying the Director, the CEM must give the person
a written notice that:
- sets
out the reasons why the CEM is of the opinion that the person has not taken
action specified in the agreement that is necessary to give effect to the
agreement and
- invites
the person to make written submissions to the CEM (within a specified period of
not less than 14 days after the notice is given) about why the CEM should not
notify the Director
and consider any submissions provided by the person.
If the CEM proceeds with notifying the Director under proposed
paragraph 94(4)(da), the Director may publish certain particulars about the
person (see further below).[31]
Clarification of the ability of the
Director to refer a person to a PSR Committee
Upon completing a review of the provision of services by a
practitioner, the Director of PSR can refer the matter to the relevant PSR
Committee to investigate whether the person under review engaged in
inappropriate practice in providing the services specified in the referral.[32]
Similar to the proposed changes in items 3 and 4
of the Bill, items 19 and 20 insert proposed subsection
93(1A) to clarify that the Director may only make a referral to a PSR
Committee where it appears to the Director that the person under review may
have:
- provided
services during the review period and
- engaged
in inappropriate practice in the provision of services.
The Explanatory Memorandum provides that these amendments
are intended to clarify ‘that is has never been part of the PSR scheme that the
Director makes any findings in relation to inappropriate practice before
referring a matter to a PSR Committee’.[33]
Rights of bodies corporate at PSR
Committee hearings
Section 102 of the HIA provides for a PSR Committee
to give the person under review a notice advising that the Committee proposes
to hold a hearing and requiring the person under review to appear and give
evidence.
Item 1 of the Bill amends subsection 81(1) to define
an executive officer of a body corporate to mean ‘a person, by whatever name
called and whether or not a director of the body, who is concerned in, or takes
part in, the management of the body corporate’.
Item 23 of the Bill inserts proposed subsection
102(5) to allow the PSR Committee to issue a notice requiring an executive
officer of a body corporate to appear at a hearing.
Item 28 inserts proposed section 103A which
sets out the rights of a body corporate at a hearing. These are broadly similar
to the rights provided to an individual in section 103 of the HIA,
though as a body corporate does not have a ‘character’, the right to produce
statements as to one’s character has been removed. Proposed subsection 103A(2)
also allows an executive offer to call a witness on their behalf to respond to
a question put by the PSR Committee, noting that if the witness answers the
question then the executive officer is taken to have answered the question.
Item 32 inserts proposed section 104A which clarifies
how a hearing will proceed where the executive officer of a body corporate has
failed to appear at a hearing, give evidence, or answer a question.
Item 34 inserts proposed section 105AA
which makes it an offence of strict liability for an executive officer of a
body corporate to fail to either appear at a hearing, give evidence at a
hearing, or answer questions. The maximum penalty is 30 penalty units ($6,660)
for an individual and 150 penalty units for a body corporate ($33,000).[34]
The Explanatory Memorandum notes that the maximum penalty
is in line with the maximum penalty recommended for non-compliance offences by
the Attorney-General’s Department A Guide to
Framing Commonwealth Offences, Infringement Notices and Enforcement Powers.[35]
While the penalty for practitioners who fail to either appear at a hearing,
give evidence at a hearing, or answer questions is only 20 penalty units ($4,440),[36]
practitioners may also be disqualified under section 105 of the HIA.
The Government states that these amendments will ‘ensure
that appropriate consequences exist for all persons who do not produce
documents when required’ and the new offence provisions are reasonable and
proportionate to the Government’s objective to protect the integrity of the PSR
scheme.[37]
Increased penalties for the refusal
or failure to produce documents or information
Section 106ZPN of the HIA currently makes it an
offence for a person (other than a person under review) to intentionally refuse
or fail to produce documents or give information requested in a notice issued
by either the Director of PSR or a PSR Committee. The maximum penalty is
currently 20 penalty units ($4,440).
Item 41 of the Bill repeals and replaces 106ZPN to
expand its application to all persons (other than persons under review who are
practitioners) and to increase the maximum penalty to 30 penalty units
($6,660). While practitioners will no longer be subject to this offence,
section 106ZPM provides that practitioners may be disqualified for failing to
produce documents.
Proposed subsection 106ZPN(2) also introduces a
civil penalty provision for body corporates with a maximum penalty of 30
penalty units (currently $6,660). Proposed subsection 106ZPN(3) provides
for separate contravention of proposed subsection 106ZPN(2) for each day that
the body corporate continues to fail to produce the documents.[38]
Item 41 also inserts proposed section 106ZPNA
which allows for the Director of PSR to apply to the Federal Court of Australia
for a court order compelling a body corporate to produce documents or give
information. The Explanatory Memorandum notes that this provision is similar to
section 70 of the Australian
Securities and Investments Commission Act 2001.[39]
Expansion of the power of the
Director to publish information about a person
Following a final determination by the Determining
Authority coming into effect, subsection 106ZPR(1) of the HIA allows
the Director of PSR to publish, in a manner he or she thinks is most
appropriate:
- the
name and address of the person under review
- the
profession or specialty of the person under review
- the
nature of the conduct of the person under review in respect of which the PSR Committee
found that the person had engaged in inappropriate practice and
- the
directions contained in the final determination.
Item 43 of the Bill inserts proposed subsection
106ZPR(1A) which expands the circumstances in which the Director may
publish the particulars of a person to include where a person has not fulfilled
their obligations under an agreement made under section 92 of the HIA (discussed
above).
The Explanatory Memorandum states that this change ‘is
intended to provide a strong behavioural incentive for compliance with written agreements,
by signalling the potential for visible reputational consequences and loss of
public goodwill’.[40]
While acknowledging that these amendments limit a person’s
rights to privacy, as set out in Article 17 of the International
Covenant on Civil and Political Rights (ICCPR),[41]
the Government argues that these amendments are a necessary limitation to this
right in order to ‘protect the integrity of the PSR process’.[42]
Proposed subsection 106ZPR(1A) also reflects
that, following the enactment of the Bill, the Director of PSR will now be able
to enter into agreements with bodies corporate and the Director will be able to
publish the particulars with respect to body corporates who do not fulfil their
obligations under their agreements. Items 44, 45 and 46 of the
Bill amend subsection 106ZPR(1) to clarify the types of particulars that can be
published by the Director of PSR.
Part 2 – Review of certain
debt-recovery decisions
The Health Legislation
Amendment (Improved Medicare Compliance and Other Measures) Act 2018 (the
Improved Medicare Compliance Act) introduced new debt-recovery powers
for Medicare debts owed to the Commonwealth, including:
- allowing
Medicare to withhold up to 20 percent of payments under the MBS to pay off
debts owed by practitioners to the Commonwealth and
- allowing
for shared debt arrangements between practitioners and their employers with
respect to debts owed to the Commonwealth under the MBS and
- the
power to garnishee certain funds so that debts owed to the Commonwealth under
the MBS, PBS and CBDS can be repaid by a third party and
- allowing
for shared debt arrangements between practitioners and their employers.
A garnishee arrangement ‘allows the Commonwealth to
recover a debt from a debtor by recovering the debt from a third party (for
example, a bank or an employer) in circumstances where that third party owes
money to a debtor’.[43]
The Improved Medicare Compliance Act amended the HIA,
NHA and DBA to allow the Commonwealth to issue garnishee notices
with respect to debts owed to the Commonwealth under the MBS, PBS and CDBS.
The amendments also allowed a person owing a debt to the
Commonwealth (the debtor) with respect to the MBS, PBS and CDBS to apply to the
Administrative Appeal Tribunal (AAT) for a review of:
- a
reconsidered debt decision (where a decision has already been reviewed by the
CEM)[44]
- an
assessment by the CEM of the debtor’s liability to pay an administrative
penalty[45]
and
- the
decision to issue the garnishee notice.[46]
The Improved Medicare Compliance Act amended the HIA
to allow for the AAT to undertake reviews relating to shared debt
determinations made by the CEM (shared debt determinations cannot be made with
respect to the PBS or CDBS).[47]
Items 50–57 of the Bill amend the HIA, NHA
and DBA to amend the circumstances in which the debtor can make an
application to the AAT to seek a review of:
- a
reconsidered debt decision
- an
assessment by the CEM of the debtor’s liability to pay an administrative
penalty or
- a
shared debt determination under the HIA.
Specifically, the proposed amendments clarify that a
debtor may only make one application to the AAT with respect to a reconsidered
decision/notice of assessment/shared debt determination even where multiple
garnishee notices have been issued in relation to the debt. The Explanatory
Memorandum provides that the purpose of these amendments is to ensure that the
AAT is not required to review the same debt decision more than once, ‘to
improve efficiencies and timeliness of debt recovery’.[48]
Part 3 – Miscellaneous debt-recovery
amendments
Following the enactment of the Improved Medicare
Compliance Act, Part 3 of the Bill amends the HIA, NHA
and DBA to make a number of minor amendments to the debt-recovery
provisions in those Acts.
These include amendments which:
- expand
the situations in which the Commonwealth can seek to recover payment from a
deceased person’s estate through allowing the CEM to issue notices for the repayment
of an administrative penalty and/or to issue shared debt determinations to a
person’s estate[49]
- clarify
that, for shared debt determinations, administrative penalties apply where the
sum of the recoverable amounts to which a determination relates is more than
$2,500 or if a higher amount is prescribed by the Regulations – that higher
amount (currently administrative penalties only arise with respect to shared
debt determinations where the cost of the service exceeds $2,500)[50]
- expand
the application of existing financial gathering information powers in the HIA
to a wider range of scenarios[51]
and
- provide
for the Commonwealth to recover the interest payable on debts through allowing
Medicare to withhold payments where interest is owed, or by allowing the
Commonwealth to recover the interest payable by way of a garnishee arrangement.[52]
Extension of civil penalty provisions where a person has failed to notify
the CEM of change in their address
Currently, under the HIA, NHA and DBA,
a person who has been served a notice informing them they owe a debt to the
Commonwealth has an obligation to notify the CEM of their address, for the
purposes of giving the person documents relating to their debt, within 14 days
of either having received a notice or following a subsequent change of address.[53]
A person who fails to notify the CEM of their change in address incurs a civil
penalty of 20 penalty units ($4,440).
Part 3 of the Bill extends the application of
existing civil penalty provisions in the HIA, NHA and DBA to
body corporates, with a maximum penalty of 100 civil penalty units ($22,200).[54]
Item 82 of the Bill amends the HIA to also expand the
circumstances in which a person or body corporate is required to notify the CEM
of a change in their address to cover a wider range of Medicare debts.
Expansion of garnishee arrangements
As discussed above, the Improved Medicare Compliance
Act amended the HIA, NHA and DBA to allow the
Commonwealth to issue garnishee notices with respect to debts owed to the
Commonwealth under the MBS, PBS and CDBS.
Items 85 and 86 of the Bill operate to extend the
power of the CEM to issue garnishee notices to include PSR debts raised
following an agreement between the Director of PSR and the person/body
corporate under section 92 of the HIA.
Item 87 of the Bill inserts proposed subsection
129AEG(1A) which provides that the CEM can only issue a garnishee notice
where a person/body corporate has defaulted in repaying their debt as required
under the agreement, or where the end of the relevant period has expired and
the amount remains unpaid and the person has not entered into an arrangement
with the CEM to repay to the amount. Item 87 also inserts proposed
subsection 129AEG(1B) which defines relevant period to mean:
- the
period of three months beginning on the day the agreement under section 92
takes effect or
- such
longer period as the CEM allows.
Part 4 – False or misleading
information
In December 2020, the Government enacted the Health Insurance
Amendment (Compliance Administration) Act 2020 which amended the HIA
to clarify the circumstances in which the Commonwealth can recover a Medicare
benefit or payment where it has been provided on the basis of false or
misleading information—regardless of the form in which that information is
provided.[55]
Specifically, subsections 129AC(1) and 129ACA(1) of the HIA
were amended to replace references to ‘making a false or misleading statement’
with references to the ‘giving of false or misleading information’. The Health Insurance
Amendment (Compliance Administration) Act 2020 also inserted
subsections 129AC(1AAA) and 129ACA(1A) into the HIA to clarify that it
is immaterial what form the information is provided in.
The Government states that these amendments:
… reflected the fact that the design parameters of electronic
claiming mechanisms are built to achieve efficiencies and therefore may no
longer support the inclusion of a specific statement or declaration being made
by a person in relation to a Medicare claim which is submitted electronically.
The intent was to ensure that postpayment compliance activities are not
constrained by technological advances with electronic Medicare claiming
mechanisms, by capturing broad circumstances in which false or misleading information
may be given, regardless of whether a person makes manual or electronic
Medicare claims.[56]
However, while the Health Insurance
Amendment (Compliance Administration) Act 2020 amended the HIA, the
NHA and DBA continued to retain references to ‘false and
misleading statements’.
Items 98-101 and 103-106 of the Bill amend
the NHA and DBA respectively to replace references in those Acts
to ‘making a false or misleading statement’ with references to the ‘giving of
false or misleading information’. Items 102 and 107 of the Bill
amend the NHA and DBA clarify that it is immaterial what form the
information is provided in.
Concluding
comments
The Bill strengthens the ability of the Commonwealth to
recover debts owed by health providers and makes a number of administrative
changes to existing measures. Overall, the proposed amendments appear to be
uncontroversial and unopposed by stakeholders.