Commonwealth Consolidated Acts

HEALTH INSURANCE ACT 1973 - SECT 129AAH

Amount paid substantiated

  (1)   If:

  (a)   a person produces to the Chief Executive Medicare (the CEO ), or to a Departmental employee (within the meaning of the Human Services (Medicare) Act 1973 ), a document, extract or copy relating to a professional service after being requested, or required under section   129AAD, to do so; and

  (b)   the CEO decides that the information contained in the document, extract or copy properly substantiates that the amount paid, by way of benefit or payment under this Act, in respect of the service, should have been paid;

the CEO must give the person written notice of the decision.

Circumstances beyond control exist

  (2)   If the CEO is satisfied, for the purposes of subsection   129AC(1B) or (1D), that circumstances beyond a person's control exist, the CEO must give the person written notice of the decision.

  (3)   If the CEO is satisfied, for the purposes of subsection   129AC(1F), that circumstances exist beyond the control of:

  (a)   the person from whom the amount concerned is recoverable; and

  (b)   the recipient of the notice concerned;

the CEO must give written notice of the decision to the person from whom the amount concerned is recoverable.

Notice may include notice of other decisions

  (4)   The CEO's written notice to a person of a decision may include written notice of other decisions referred to in this section, or section   129AAI, that also are required to be given to the person.

Giving notices to State and Territory Health Departments

  (5)   If:

  (a)   any of the following is given to a person in relation to a professional service rendered by the person:

  (i)   a notice under subsection   (1);

  (ii)   a notice under subsection   (2);

  (iii)   a notice under subsection   (3); and

  (b)   the professional service was rendered, or purportedly rendered, in or at a hospital mentioned in subsection   (6) of a State or Territory;

then, a copy of the notice may be given to the head (however described) of the Health Department (within the meaning of the National Health Reform Act 2011 ) of that State or Territory.

  (6)   For the purposes of subsection   (5), a hospital is a facility in that State or Territory for which:

  (a)   a declaration is in force under paragraph   121 - 5(6)(a) of the Private Health Insurance Act 2007 ; and

  (b)   a statement is included in the declaration (as mentioned in subsection   121 - 5(8) of that Act) that the hospital is a public hospital.