Barristers and Solicitors
Ph: 1300 302 604

Frequently Asked Questions

1. Is there a time limit placed on the Health Insurance Commission in its prosecution of Practitioners?

   Yes, under the Health Insurance Act 1973, referrals can only relate to a period of 2 years prior to the date on which a referral is issued.
    

2. What happens if I get a referral?

   You should immediately seek legal advice. At the initial stage, you will be given the opportunity to make a submission to the Director of Professional Services. The Director may dismiss a referral if satisfied that the Professional Services Review Panel would not make a finding of inappropriate practice, and this decision will often depend on the practitioner's submission.
    

3. What happens after a Referral is successfully challenged in the Federal Court?

   If the Federal Court rules that the Referral is invalid for jurisdictional or other error, the Director of Professional Review Scheme and the members of the Professional Review Committee cannot continue with the Referral.

   The Director of Professional Review Scheme can only issue a fresh referral in respect of a period not exceeding two years prior to the date of issue.
    

4. What is the 80/20 rule?

   Under the Health Insurance Act 1973 read in conjunction with the Health Insurance (Professional Services Review) Regulations 1999, if during a particular period, the circumstances in which some or all of the referred services were rendered or initiated constituted a prescribed pattern of services, the conduct of the person initiating the services is taken to constitute engaging in inappropriate practice. Prescribed pattern of services is defined in the Regulations as circumstances in which 80 or more services are rendered on each of 20 or more days in a 12 month period.