Health Insurance Amendment Act (No. 1) 1997

Legislation au C2004A05239 Not in force Act

Legislation content

 

 

 

 

Health Insurance Amendment Act (No. 1) 1997

 

No. 146, 1997

 

 

 

 

 

 

 

 

 

Health Insurance Amendment Act (No. 1) 1997

 

No. 146, 1997

 

 

 

 

An Act to amend the Health Insurance Act 1973, and for related purposes

 

Contents

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

2 Commencement..............................1

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

4 Application of certain amendments...................2

Schedule 1—Amendment of the Health Insurance Act 1973 3

 

Health Insurance Amendment Act (No. 1) 1997

No. 146, 1997

 

 

 

An Act to amend the Health Insurance Act 1973, and for related purposes

Assented to 9 October 1997

The Parliament of Australia enacts:

1  Short title

  This Act may be cited as the Health Insurance Amendment Act (No. 1) 1997.

2  Commencement

  This Act commences on the 28th day after the day on which it receives the Royal Assent.

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  Each Act that is specified in a Schedule to this Act is amended or repealed as set out in the applicable items in the Schedule concerned, and any other item in a Schedule to this Act has effect according to its terms.

4  Application of certain amendments

  The amendments made by items 1, 2, 3, 7, 12 and 13 of Schedule 1 do not apply to matters referred under section 86 of the Health Insurance Act 1973 before the commencement of this Act.

 

Schedule 1—Amendment of the Health Insurance Act 1973

1  Paragraph 80(4)(c)

Repeal the paragraph.

2  Subsection 81(2)

Repeal the subsection.

3  Paragraphs 82(1)(a) and (b)

Repeal the paragraphs, substitute:

 (a) if the practitioner rendered or initiated the referred services as a general practitioner—the conduct would be unacceptable to the general body of general practitioners; or

 (b) if the practitioner rendered or initiated the referred services as a specialist (other than a consultant physician) in a particular specialty—the conduct would be unacceptable to the general body of specialists in that specialty; or

 (c) if the practitioner rendered or initiated the referred services as a consultant physician in a particular specialty—the conduct would be unacceptable to the general body of consultant physicians in that specialty; or

 (d) if the practitioner rendered or initiated the referred services as neither a general practitioner nor a specialist but as a member of a particular profession—the conduct would be unacceptable to the general body of the members of that profession.

4  Subsection 85(2)

Repeal the subsection.

5  At the end of section 86

Add:

 (5) If, after 30 June 1994 but before the commencement of this subsection, a member of the Commission’s staff (within the meaning of the Health Insurance Commission Act 1973) purported to refer conduct of a person to the Director under this section, then for all purposes:

 (a) the referral is taken to be, and always to have been, made by the Commission; and

 (b) all proceedings, matters, acts and things taken, made or done (or purporting to have been taken, made or done) because of the referral are taken to have, and always to have had, the same force and effect as they would have, or would have had, if the referral in fact had been made by the Commission.

6  At the end of paragraph 87(1)(b)

Add:

 ; (iv) services provided within a specified period.

7  Subsection 95(5)

Omit the subsection, substitute:

 (5) If the practitioner was at that time a general practitioner, the other Panel members referred to in paragraph (1)(b) must also be general practitioners.

8  Paragraph 104(1)(b)

Repeal the paragraph, substitute:

 (b) appear at the hearing and produce such documents as are referred to in the notice.

9  After subsection 104(4)

Insert:

 (4A) If the person under review is required by the notice under subsection (2) to produce such documents as are referred to in the notice, the person must appear at the hearing and produce those documents.

Penalty: 20 penalty units.

10  After section 105

Insert:

105A  Persons to produce documents prior to hearing

 (1) The Committee may by written notice require a person (including the person under review) to produce such documents as are referred to in the notice prior to the hearing.

 (2) The notice must be given at least 7 days before the day on which the person is required to produce the documents.

 (3) The person must produce the documents to a Committee member, or another person nominated by a Committee member, at the time and place specified in the notice.

Penalty: 20 penalty units.

 (4) If a document is produced prior to a hearing:

 (a) a Committee member may inspect the document; and

 (b) a Committee member may retain the document in his or her possession for such reasonable period as he or she thinks fit; and

 (c) a Committee member may make copies of, or take extracts from, the document.

 (5) A person must not knowingly produce a document that contains a statement that is false or misleading in a material particular, without identifying the respects in which he or she knows it to be false or misleading.

Penalty: 20 penalty units.

 (6) A person (other than the person under review) is not excused from producing a document under subsection (3) on the ground that the production of the document may incriminate the person.

 (7) A document produced under subsection (3), and any information or thing (including a document) obtained as a direct or indirect result of producing the document, is not admissible in evidence against the person in any criminal proceedings or proceedings for recovery of a pecuniary penalty.

 (8) Subsection (7) does not apply in proceedings for an offence against subsection (5).

11  After section 106E

Insert:

106EA  Contempt of Committee

  A person must not:

 (a) obstruct or hinder the Committee or a Committee member in the performance of the functions of the Committee; or

 (b) disrupt a hearing before the Committee.

Penalty: 20 penalty units.

12  Subdivision C of Division 4 of Part VAA

Repeal the Subdivision.

13  Subsection 106L(1)

Repeal the subsection, substitute:

 (1) The Committee must give to the Determining Officer a written report setting out its findings on whether, in its opinion, the person under review engaged in inappropriate practice in connection with the referred services.

14  Subsection 106M(1)

Omit “90”, substitute “120”.

15  After section 106M

Insert:

106MA  Copy of report to Director

  As soon as practicable after making its report, the Committee must give a copy of it to the Director.

16  Subsection 106P(1)

Omit “and imminent”.

17  Division 5 of Part VAA (heading)

Repeal the heading, substitute:

Division 5—Determinations and referrals by the Determining Officer

Subdivision A—Determinations by the Determining Officer

18  Paragraph 106U(1)(c)

Repeal the paragraph, substitute:

 (c) that the person under review repay to the Commonwealth the whole or a part of the medicare benefit that was paid (whether or not to the person under review) in respect of services that:

 (i) were rendered by:

 (A) the person under review; or

 (B) an employee of the person under review; or

 (C) an employee of a body corporate of which the person under review is an officer; and

 (ii) are services in connection with which the person under review is stated in a report under section 106L to have engaged in inappropriate practice;

  and that any medicare benefit that would otherwise be payable for the services cease to be payable;

19  Paragraph 106U(1)(d)

Repeal the paragraph.

20  Paragraph 106U(1)(f)

Omit “inappropriate service”, substitute “service in connection with which the person is stated in a report under section 106L to have engaged in inappropriate practice”.

21  Subsection 106U(3)

Omit “12 months”, substitute “3 years”.

22  Subsection 106U(4)

Omit “6 months”, substitute “3 years”.

23  Subsection 106U(5) (definition of inappropriate service)

Repeal the definition.

24  After section 106U

Insert:

106UA  Notification of final determination before it takes effect

  As soon as practicable after making a final determination, the Determining Officer must give copies of it to the person under review and the Director.

25  After section 106X

Insert:

Subdivision B—Referrals by the Determining Officer

106XA  Referring matters to other professional bodies

 (1) If the Determining Officer thinks that the material before him or her indicates that action may be required against the person under review, the Officer may give the material, together with a written statement of the Officer’s concerns, to:

 (a) if the person under review is a general practitioner—a body specified in regulations made for the purposes of paragraph 3F(6)(b) or this paragraph; or

 (b) otherwise—a body specified in regulations made for the purposes of this paragraph.

 (2) The Determining Officer must not give to a body any material that discloses the identity of a particular person unless the Officer is of the opinion that the body needs to know the identity of that person in order to properly carry out the body’s functions.

 (3) If the Determining Officer discloses the identity of a person, the Officer must advise the person in writing:

 (a) that the person’s identity has been disclosed under this section; and

 (b) of the safeguards that apply to the information.

26  After section 108

Insert:

108A  Reconstitution of a Tribunal

 (1) This section applies if a member of a Tribunal reviewing a determination is not available (for whatever reason) for the purposes of the proceedings on the review.

 (2) If the member is the President, the Minister may refer the proceedings to another Tribunal that satisfies the requirements of section 115.

 (3) If the member is not the President, the Minister may:

 (a) permit, in writing, the President and the other available member to continue with the proceedings; or

 (b) refer the proceedings to another Tribunal that satisfies the requirements of section 115.

 (4) If:

 (a) the Minister permits the President and the other member to continue with the proceedings under paragraph (3)(a); and

 (b) the President and the other member do not agree on the decision to be made on the proceedings;

then the Minister may refer the proceedings to another Tribunal that satisfies the requirements of section 115.

 (5) If:

 (a) the Minister permits the President and the other member to continue the proceedings under paragraph (3)(a); and

 (b) the other member stops being available (for whatever reason) for the purposes of the proceedings;

then the Minister may refer the proceedings to another Tribunal that satisfies the requirements of section 115.

 (6) If the Minister refers proceedings to another Tribunal, the proceedings are to be reheard by the other Tribunal.

 (7) If the Minister refers proceedings to another Tribunal, the Minister must give written notice of the referral to:

 (a) the parties to the proceedings; and

 (b) the President of the Tribunal from which the proceedings were referred (the old Tribunal); and

 (c) the President of the other Tribunal (the new Tribunal).

 (8) Upon the President of the old Tribunal receiving a notice under subsection (7), the old Tribunal must:

 (a) stop considering the matter to which the proceedings on review relate; and

 (b) forward to the President of the new Tribunal the material the old Tribunal received under section 115.

27  After paragraph 115(1)(b)

Insert:

 (ba) any exhibits, or copies of exhibits, received at the hearing conducted for the purposes of that reference;

28  Section 116

Omit “from the Minister under section 115 a request for the review of a determination”, substitute “under section 115 a request for the review of a determination, or receives under section 108A a notice of referral of proceedings on the review of a determination”.


Minister’s second reading speech made in

House of Representatives on 26 March 1997

Senate on 25 June 1997

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(56/97)


 

Overview

The Health Insurance Amendment Act (No. 1) 1997 was enacted by the Parliament of Australia to amend the Health Insurance Act 1973 and address specific issues and gaps in the legislative framework concerning health insurance practices and complaints processes. The Act was assented to on 9 October 1997 and commenced on 28 days after receiving Royal Assent. This amendment act sought to refine the criteria for unacceptable professional conduct, adjust the timelines and procedures for hearings and determinations, and enhance the mechanisms for referring cases to other professional bodies and for the reconstitution of tribunals when necessary. By introducing these changes, the Act aimed to improve the oversight and management of health insurance complaints, ensuring they are handled efficiently and fairly.

Scope and Application

The Health Insurance Amendment Act (No. 1) 1997 applies to the amendments and repeals within the Health Insurance Act 1973, targeting the regulation of health insurance practices and the conduct of practitioners who provide services under the scheme. This legislation specifically affects health insurance providers, medical practitioners, and the Health Insurance Commission, aiming to refine the criteria for unacceptable conduct and improve the processes for referring, reviewing, and determining inappropriate practices. The Act applies nationally across Australia, impacting all states and territories within the Commonwealth. However, certain amendments outlined in the Act do not apply to matters that were referred under section 86 of the Health Insurance Act 1973 prior to the commencement of this Act. The scope of the Act can be further extended or modified through subordinate instruments, allowing for the regulation and administration of health insurance practices to be adapted as necessary to address emerging issues or changes in the healthcare landscape.

Key Provisions

The Health Insurance Amendment Act (No. 1) 1997 (C2004A05239) primarily amends the Health Insurance Act 1973 (C2004A00546) by updating various provisions to ensure the efficient and fair administration of health insurance practices in Australia. Key sections in the Act include the amendment of definitions, responsibilities, and procedures related to health insurance conduct, referrals, and disciplinary actions against practitioners (sections 3, 4, 5, 10, 11, 18, 20, 24, 25). These sections redefine unacceptable conduct by healthcare practitioners, clarify the process for document production and hearings, and modify the penalties and consequences for non-compliance. The Act imposes several obligations on healthcare practitioners and the entities involved in the administration of health insurance. Healthcare practitioners must adhere to the standards of conduct outlined in the Act, ensuring that their services meet the acceptable standards of their respective professional bodies (section 3). Additionally, the Act requires practitioners to produce documents and attend hearings as specified, under penalty of 20 penalty units (sections 10, 11). The Health Insurance Commission and its committees are mandated to follow the updated procedures for referrals, reviews, and determinations, including the timely notification of final determinations and referrals to relevant professional bodies (sections 5, 24, 25, 106XA). Violations of the Act's provisions can lead to significant consequences. Practitioners who fail to produce required documents or provide false or misleading information face a penalty of 20 penalty units (section 10(6)). Similarly, obstructing or disrupting a committee or its members during hearings can result in the same penalty (section 11). Additionally, the Act specifies that documents produced under the Act and any information derived from them are not admissible in criminal proceedings against the producer, except in cases of producing false or misleading statements (section 10(7), (8)). These measures ensure that the administration of health insurance remains rigorous and fair, protecting both practitioners and the public.

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Sourced from the Federal Register of Legislation at 26 August 2026. For the latest information on Australian Government law please go to https://www.legislation.gov.au.