Dental Benefits Act 2008

If the Chief Executive Medicare believes on reasonable grounds that:

a person:

who rendered a dental service in respect of which an amount has been paid that is the subject of the Chief Executive Medicare’s concern referred to in paragraph 32B(1)(a); or

on whose behalf such a dental service was rendered; or

another person, not being:

the person in respect of whom the dental service was rendered; or

the person who incurred the dental expenses in respect of the service;

For a person referred to in paragraph (a), failure to comply with a notice may lead to debt recovery action (see section 56A). For a person referred to in paragraph (b), failure to comply with a notice may lead to a civil penalty (see section 32D).

The Chief Executive Medicare may require the person, in relation to each dental service specified in the notice:

subject to subsection (3), to produce to the Chief Executive Medicare, or a Human Services employee, any document, or extract of any document, that is relevant for the purpose set out in subsection (1); or

to make a copy of any such document or extract and to produce that copy to the Chief Executive Medicare or a Human Services employee.

If a document, extract or copy contains clinical details relating to an individual, the person to whom the notice is given is not required to produce the document, extract or copy to a person other than a Human Services employee who is a dental practitioner or a medical practitioner.

The Chief Executive Medicare must not give a notice to a person under subsection (1) in respect of a dental service unless the Chief Executive Medicare has given the person a reasonable opportunity to respond to a written request to produce to the Chief Executive Medicare, or a Human Services employee, documents relevant to ascertaining whether the amount paid, purportedly by way of dental benefit, in respect of the service, should have been paid.

A notice under subsection (1) can only be given in respect of a dental service for which an amount was claimed under this Act in the period of 2 years immediately before the day a written request under subsection (4) was first given to the person in relation to one or more dental services specified in the notice.

A notice under subsection (1) must:

specify details of each dental service (including the item, date on which the service was rendered and medicare number of the person in respect of whom the service was rendered) in relation to which the document, extract or copy is to be produced; and

specify the reason or reasons for the Chief Executive Medicare’s concern that an amount paid, purportedly by way of dental benefit, in respect of each such service may exceed the amount (if any) that should have been paid; and

specify the information relevant to ascertaining whether amounts paid in respect of each such service should have been paid; and

specify how the document, extract or copy is to be produced; and

contain a statement to the effect that the person to whom the notice is given is not expected to produce a document, extract or copy containing clinical details relating to an individual unless the document, extract or copy is necessary to ascertaining whether the amount paid in respect of the service should have been paid; and

specify the period within which, and place at which, the document, extract or copy is to be produced.

For the purpose of paragraphs (b) and (c) the notice will include the reason for the Chief Executive Medicare’s concern about the payment and explain the factual issue that the person is required to substantiate.

The power under this section to require a document, extract or copy to be produced includes the power to require the production of a document, extract or copy containing health information (within the meaning of the Privacy Act 1988) about an individual.

If requested to do so under subsection (4), a person is authorised to produce any document relevant to the request, including a document containing health information (within the meaning of the Privacy Act 1988) about an individual.

This section is not limited by:

any other provision of this Act; or

any provision of the Human Services (Medicare) Act 1973 or any other Act;