Debt recovery for Medicare programmes 107-21042124

Policy

Program Delegations and Authorisations Register

Medicare Services, Delegations and Authorisations

Legislation

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Public Governance, Performance and Accountability Rule 2014, rule 11, Recovery of debts

Health and Other Services (Compensation) Act 1995

Health Insurance Act 1973

Medicare Compliance

• Section 125D Obtaining an order for a civil penalty – Recovery of a pecuniary penalty
• Section 129AC Recovery of amounts overpaid etc. and administrative penalties
• 129AE Recovery of amounts paid in respect of certain diagnostic imaging services

Aged Care Act 2024

Aged Care Rules 2025

National Health Act 1953

Continence Aids Payment Scheme (CAPS)

• By legislative instrument - Continence Aids Payment Scheme 2020, Section 23

Pharmaceutical Benefits scheme (PBS)

• Section 99AAA Claim for payment relating to supply of benefits

Human Services (Medicare) (Medicare Programs) Specification 2021

• External Breast Prostheses Reimbursement Program (EBPRP)
• Australian Immunisation Register (AIR)

Veterans' Entitlements Act 1986

Repatriation PBS

• Section 91 Repatriation Pharmaceutical Benefits Scheme

Historical Legislation

Aged Care Act 1997

Aged Care

• Part 6.5 Recovery of Overpayments / Division 95
• 95-3 Recovery by deductions from amounts payable to debtor
• 95-4 Recovery where there is a transfer of places
• 95-6(a) Write off of debt
• 95-6(b) Waiver of debt
• 95-6(c) Allows debt payments by instalment