Commonwealth Consolidated Acts

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HEALTH INSURANCE ACT 1973 - SECT 93

Referral to a Committee

  (1A)   This section applies if it appears to the Director that a person under review may have:

  (a)   provided services during the review period; and

  (b)   engaged in inappropriate practice in the provision of the services.

  (1)   The Director may, by writing, set up a Committee in accordance with Division   4, and make a referral to the Committee to investigate whether the person under review engaged in inappropriate practice in providing the services specified in the referral.

Note:   Investigating whether the person under review engaged in inappropriate practice in providing the services may include investigating whether the services were provided by the person or another person.

  (2)   If the referral arises from a request made by a Committee to the Director under subsection   106J(1), the Director may, instead of setting up a Committee under subsection   (1), make the referral to the Committee that made the request.

  (3)   Subject to this section, the content and form of a referral must comply with any guidelines made under subsection   (4).

  (4)   The Minister may, by legislative instrument, make guidelines about the content and form of referrals.

  (6)   If the Director makes a referral, the Director must:

  (a)   prepare a written report for the Committee, in respect of the services to which the referral relates, giving reasons why it appears to the Director that the person under review may have engaged in inappropriate practice in providing the services; and

  (b)   attach the report to the referral.

Note:   The reasons given by the Director may relate solely to the services being rendered or initiated in circumstances that constitute a prescribed pattern of services.

  (7)   Within 7 days after making the referral, the Director must give a copy of the referral and report to the Chief Executive Medicare and the person under review.

  (7A)   The copy given to the person under review must be accompanied by a written notice setting out the terms of sections   102, 106H and 106K.

  (7B)   The services that may be specified in the referral are any or all of the services provided by the person under review during the review period.

  (7C)   Subsection   (7B) is not limited by the terms of the Director's report under subparagraph   89C(1)(b)(i).

  (7D)   Failure to comply with subsection   (7) or (7A) does not affect the validity of the referral.

  (8)   If, in the course of the review that gave rise to the referral:

  (a)   the Director formed an opinion that any conduct by the person under review caused, was causing, or was likely to cause, a significant threat to the life or health of any person and sent a statement of his or her concerns to a person or body under section   106XA; or

  (b)   the Director formed an opinion that the person under review failed to comply with professional standards and sent a statement of his or her concerns to an appropriate body or bodies under section   106XB;

the referral must contain a statement that the Director formed that opinion and set out the terms of the statement sent to the person, body or bodies.

  (9)   The Director must disregard any opinion formed as mentioned in subsection   (8) when making the referral.


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