Commonwealth Consolidated Acts

HEALTH INSURANCE ACT 1973 - SECT 19B

  (1)   In this section:

"partly disqualified" means disqualified (other than fully disqualified), or taken to be disqualified (other than fully disqualified), under an agreement that was in effect under section   92 or under a final determination under section   106TA or a determination under Part   VB.

"practitioner" has the same meaning as in section   124B.

  (2)   A medicare benefit is not payable in respect of a professional service (including a pathology service) if:

  (a)   at the time when the service was rendered, the person who rendered the service, or the practitioner on whose behalf the service was rendered, was a practitioner:

  (iaa)   who was fully disqualified under an agreement that was in effect under section   92; or

  (ia)   who was fully disqualified under section   105; or

  (ib)   in relation to whom a final determination under section   106TA containing a direction under paragraph   106U(1)(h) that the practitioner be fully disqualified was in effect; or

  (i)   in relation to whom a determination under paragraph   124F(2)(e) or 124FF(2)(d) that the practitioner be fully disqualified was in effect; or

  (ii)   who was taken to be fully disqualified because a determination under paragraph   124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect; or

  (b)   at the time when the service was rendered, the person who rendered the service, or the practitioner on whose behalf the service was rendered, was a practitioner:

  (ia)   who was partly disqualified under an agreement that was in effect under section   92 in respect of that service; or

  (ib)   in relation to whom a final determination under section   106TA containing a direction under paragraph   106U(1)(g) that the practitioner be partly disqualified was in effect in respect of that service; or

  (i)   in relation to whom a determination under paragraph   124F(2)(d) or 124FF(2)(d) that the practitioner be partly disqualified was in effect in respect of that service; or

  (ii)   who was taken to be partly disqualified because a determination under paragraph   124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect in respect of that service; or

  (c)   the service was initiated by a person other than the person who rendered the service, and the person who initiated the service, or the practitioner on whose behalf the service was initiated, was a practitioner:

  (ia)   who was fully disqualified under an agreement that was in effect under section   92; or

  (i)   who was fully disqualified under section   105; or

  (ii)   in relation to whom a final determination under section   106TA containing a direction under paragraph   106U(1)(h) that the practitioner be fully disqualified was in effect; or

  (iii)   in relation to whom a determination under paragraph   124F(2)(e) or 124FF(2)(d) that the practitioner be fully disqualified was in effect; or

  (iv)   who was taken to be fully disqualified because a determination under paragraph   124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect; or

  (d)   the service was initiated by a person other than the person who rendered the service, and the person who initiated the service, or the practitioner on whose behalf the service was initiated, was a practitioner:

  (i)   who was partly disqualified under an agreement that was in effect under section   92 in respect of that service; or

  (ii)   in relation to whom a final determination under section   106TA containing a direction under paragraph   106U(1)(g) that the practitioner be partly disqualified was in effect in respect of that service; or

  (iii)   in relation to whom a determination under paragraph   124F(2)(d) or 124FF(2)(d) that the practitioner be partly disqualified was in effect in respect of that service; or

  (iv)   who was taken to be partly disqualified because a determination under paragraph   124F(2)(f) or 124FF(2)(e) or (f) in relation to another person was in effect in respect of that service.

  (3)   A medicare benefit is not payable in respect of a pathology service if at the time when the service was rendered, the person by whom or on whose behalf the service was rendered was a person in relation to whom a determination of the kind referred to in subparagraph   124FB(1)(e)(vi) was in effect in respect of that service.