EXPLANATORY STATEMENT
STATUTORY RULES 1983 NO. 70
HEALTH INSURANCE COMMISSION ACT 1973
HEALTH INSURANCE COMMISSION REGULATIONS (AMENDMENT)
Issued by Authority of the Minister for Health
Section 44 of the Health Insurance Commission Act 1973 (‘the Act’) provides that the Governor-General may make regulations, not inconsistent with the Act, prescribing all matters required or permitted by the Act to be prescribed or necessary or convenient to be prescribed for carrying out or giving effect to the Act.
Parts II and IIA of the Act respectively set out the functions of the Health Insurance Commission (“the Commission”) in relation to the medicare scheme and the conduct of medibank private. Sub-section 8E(1) in Part IIB of the Act provides that in addition the Commission shall perform such functions in relation to health insurance as are prescribed and such functions in relation to other matters relating to health as are prescribed.
The purpose of the regulations is to prescribe, for the purposes of sub-section 8E(1) of the Act, additional functions to be performed by the Commission.
Broadly speaking, these additional functions, previously carried out by the Department of Health, relate to the investigation and general control of the overall incidence of medicare fraud and over-servicing.
More specifically these functions are as follows:
• the devising and implementation of measures designed to -
i) control and reduce the incidence of over-servicing on the part of medical and dental practitioners and optometrists;
ii) facilitate the detection of such cases of overservicing; and
iii) prevent or facilitate the detection of fraudulent medicare benefit claims;
• the investigation of cases of suspected over-servicing and referral, where appropriate, of them to the Minister for Health for further action;
• the investigation of suspected cases of fraudulent medicare benefit claims and other offences against provisions of the Health Insurance Act 1973 or the Crimes Act 1914;
• the administrative duties involved in the implementation and operation of the provisions of the Health Insurance Act 1973 relating to the disqualification, for medicare benefit purposes, of practitioners found guilty of fraud;
• the provision of clerical and administrative services involved in the operation of the various Medical and Optometrical Services Committees of Inquiry established under the Health Insurance Act 1973; and
• the undertaking of action, on behalf of the Commonwealth, to recover from a person an amount of medicare benefit that is legally recoverable by the Commonwealth from that person.
The reason for the transfer of these functions is:
• to give effect to the principle that all operational aspects of medicare should be brought together under one administration; and
• to eliminate overlap between the Department of Health and the Health Insurance Commission in such areas as data handling, contact with members of the medical profession, and fraud investigation.
Details of the regulations are as follows:
Regulation 1 provides that the regulations come into operation on 20 May 1985; and
Regulation 2 prescribes the new functions that are to be performed by the Commission.