EXPLANATORY STATEMENT
STATUTORY RULES 1983 NO. 95
HEALTH INSURANCE ACT 1973
HEALTH INSURANCE REGULATIONS (AMENDMENT)
Issued by Authority of the Minister for Health
Section 133 of the Health Insurance Act 1973 (‘the Act’) provides in part 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.
Sub-section 130(1) of the Act provides that a person shall not, directly or indirectly, except in the performance of his duties, or in the exercise of his powers or functions, under the Act, and while he is, or after he ceases to be, an officer, make a record of, or divulge or communicate to any person, any information with respect to the affairs of another person acquired by him in the performance of his duties, or in the exercise of his powers or functions, under the Act. An “officer” is, by virtue of sub-section 130(14) of the Act, a person performing duties, or exercising powers or functions, under, or in relation to, the Act.
Paragraph 130(3)(b) of the Act provides that, notwithstanding the prohibition imposed by sub-section 130(1), information which is subject to that sub-section may be divulged by the Secretary of the Department of Health or by the General Manager of the Health Insurance Commission to any prescribed authority or person. Sub-section 130(4) of the Act, however, prohibits information so divulged from being further divulged by the recipient authority or person, and by any person or employee under the control of that person or authority.
Regulation 9B of the Health Insurance Regulations (‘the Regulations’) prescribes authorities and persons for the purposes of paragraph 130(3)(b) of the Act.
The regulations amend regulation 9B of the Regulations to prescribe, for the purposes of paragraph 130(3)(b) of the Act, a person who, for the time being, is performing the duties of either of the positions of Legal Officer, position number 7101/48, or Legal Officer, position number 7101/289, in the Complaints Unit in the Department of Health of the State of New South Wales. The State Complaints Unit has the responsibility of investigating, where
appropriate, complaints received in the office of the New South Wales Minister for Health regarding health services in New South Wales.
The prescribing, for the purposes of paragraph 130(3)(b) of the Act, of these officers of the State Complaints Unit has been necessary to permit information which is subject to sub-section 130(1) of the Act (in particular, matters relating to the investigation and prosecution of medical benefits fraud) to be communicated to them at meetings of the Commonwealth “State Co-ordinating Group on Medical Fraud”. This body was formed to assist co-ordination between agencies of the Commonwealth Government concerned with the investigation and prosecution of possible offences arising from the payment of medicare benefits under the Act. The attendance of the State officers at meetings of the Co-ordinating Group, which has been requested by the New South Wales Minister for Health, is expected to facilitate the conduct of relevant investigations by both Commonwealth and State authorities.
The draft statutory rules came into operation on the date of their notification in the Commonwealth of Australia Gazette.
Overview
The Health Insurance Regulations (Amendment) Statutory Rules 1983 No. 95 were enacted to amend the Health Insurance Regulations 1973 and address the need for better coordination between Commonwealth and State authorities in the investigation and prosecution of medical benefits fraud. The amendment was issued by authority of the Minister for Health, and the objective was to facilitate the flow of sensitive information between relevant officers in the Complaints Unit of the New South Wales Department of Health and the Commonwealth's "State Co-ordinating Group on Medical Fraud". This group was established to streamline the collaborative efforts between Commonwealth agencies involved in investigating and prosecuting possible offences related to Medicare benefits under the Health Insurance Act 1973. The regulations came into effect on the date of their notification in the Commonwealth of Australia Gazette.
Scope and Application
The Health Insurance Regulations (Amendment) Statutory Rules 1983 No. 95 pertains to specific amendments within the Health Insurance Act 1973, focusing on the regulation of information sharing in the context of health insurance matters. This amendment applies to individuals performing duties in designated legal officer positions within the Complaints Unit of the Department of Health in the state of New South Wales. These officers are granted the ability to receive and utilise sensitive information concerning health insurance fraud investigations, subject to strict confidentiality protocols as outlined in the Act. This amendment extends the scope of permitted information sharing to facilitate coordination between Commonwealth and State authorities in the investigation and prosecution of medical benefits fraud, thereby enhancing the efficiency and effectiveness of relevant investigations. The regulations, effective from the date of their notification in the Commonwealth of Australia Gazette, ensure compliance with the overarching confidentiality provisions of the Health Insurance Act while enabling necessary collaboration between different governmental bodies.
Key Provisions
The primary operative sections of the Health Insurance Regulations (Amendment) pertain to the prescribed authorities and individuals who are permitted to receive confidential information under section 130 of the Health Insurance Act 1973. Specifically, regulation 9B is amended to include individuals in two specific roles within the Complaints Unit of the Department of Health in New South Wales (section 9B). This amendment allows designated officers in these roles to receive sensitive information, particularly in relation to the investigation and prosecution of medical benefits fraud. This is necessary to facilitate better coordination between federal and state authorities in addressing fraud related to health insurance benefits.
The obligations imposed by the amended regulations on the parties concerned are primarily focused on the handling and protection of confidential information. Officers in the specified roles within the Complaints Unit must ensure that any information they receive under these provisions is kept confidential and not further divulged. They are required to adhere to the strict non-disclosure provisions outlined in section 130 of the Act. This obligation extends to any prescribed authority or person who receives such information from the Secretary of the Department of Health or the General Manager of the Health Insurance Commission.
The Act imposes serious consequences for breaches of the confidentiality provisions. Under section 130(1), any person who directly or indirectly divulges or communicates information acquired in the performance of their duties under the Act, except as permitted by the Act, commits an offence. Such an offence is subject to penalties as prescribed by law. While the specific penalties are not detailed in the explanatory statement, breaches of confidentiality in such contexts typically carry significant criminal and civil penalties, including fines and imprisonment, reflecting the sensitive nature of the information involved.