Health Insurance Act 1973

An amount is recoverable under this subsection, as a debt due to the Commonwealth, if:

the amount was paid purportedly under this Act in respect of a professional service to a person who was not entitled to be paid the amount under this Act in respect of that professional service; or

the amount was paid purportedly by way of benefit or payment under this Act to a person who was not entitled to be paid the amount under this Act by way of that benefit or payment; or

the amount was paid purportedly by way of benefit or payment under this Act, and the benefit or the right to the payment was assigned other than in accordance with section 20A.

The amount may be recovered from:

if subsection (3) applies to the amount—the person mentioned in paragraph (3)(b), or the estate of that person; or

otherwise—the person to whom the amount was paid, or the estate of that person.

This subsection applies to the amount if:

the amount was paid, purportedly by way of benefit or payment under this Act, in respect of a professional service; and

a person:

rendered or purportedly rendered the service; or

is identified, in a claim for benefit or payment under this Act, as having rendered the service; and

the amount was not in fact payable in respect of the service because:

at the time the service was rendered or purportedly rendered, the person, the service, or the rendering or purported rendering of the service, did not meet a requirement under this Act or an instrument made under this Act; or

the person, the service, or the rendering or purported rendering of the service, breached a contract between the person and the Commonwealth; or

the service was rendered or purportedly rendered by a person who was, at the time, partly or fully disqualified under this Act or an instrument or agreement made under this Act.

For the purposes of paragraph (c), an example of an amount not in fact payable in respect of a professional service is a medical benefit that, in accordance with section 19AA, is not payable because the service was rendered by a medical practitioner who did not meet the requirements under that section.

The recovery, by the Commonwealth, of an amount recoverable under subsection (1) does not preclude any other action being taken under this Act or any other Act in relation to any non‑compliance with a requirement under this Act, or an instrument made under this Act, that resulted in the amount being recoverable under subsection (1).