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HEALTH INSURANCE ACT 1973 - SECT 23DZZIAF

Debt recovery if proprietor fails to inform patient that premises or base not accredited

  (1)   If:

  (a)   a diagnostic imaging procedure used in rendering a diagnostic imaging service is carried out on a person at diagnostic imaging premises, or using equipment that is ordinarily located at diagnostic imaging premises; and

  (b)   at the time the procedure is carried out, medicare benefit is not payable in respect of the service because the premises are not accredited for the procedure under a diagnostic imaging accreditation scheme; and

  (c)   the proprietor of the premises failed to inform the person that no medicare benefit would be payable in respect of the service and of the reasons why no medicare benefit would be payable; and

  (d)   after the procedure is carried out, the Minister directs under subsection   16EA(1) that medicare benefit is to be paid in respect of the service;

an amount equal to the medicare benefit is recoverable from the proprietor as a debt due to the Commonwealth.

  (2)   If:

  (a)   a diagnostic imaging procedure used in rendering a diagnostic imaging service is carried out on a person:

  (i)   at a base for mobile diagnostic imaging equipment; or

  (ii)   using equipment that is ordinarily located at a base for mobile diagnostic equipment when not in use, and that is not ordinarily located at diagnostic imaging premises; and

  (b)   at the time the procedure is carried out, medicare benefit is not payable in respect of the service because the base is not accredited for the procedure under a diagnostic imaging accreditation scheme; and

  (c)   the proprietor of the base failed to inform the person that no medicare benefit would be payable in respect of the service and of the reasons why no medicare benefit would be payable; and

  (d)   after the procedure is carried out, the Minister directs under subsection   16EA(1) that medicare benefit is to be paid for the service;

an amount equal to the medicare benefit is recoverable from the proprietor as a debt due to the Commonwealth.


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