Insights Categories: Medicare & Private Health Insurance Audits & Investigations

Oct 28, 2020

INSIGHT: Federal Court of Australia confirms Professional Services Review (PSR) has the power to order part repayments

Professional Services Review (PSR) is a Commonwealth Agency whose objective is to protect the integrity of the Commonwealth Medicare benefits, dental benefits and pharmaceutical benefits programs and, in doing so, protect patients and the community from the risks associated with ‘inappropriate practice’, and protect the Commonwealth from having to meet the cost of medical and […]

Jun 5, 2020

INSIGHT: Private Health Insurer audits – a reminder to exercise caution and to ask for help

The world of private health insurance is becoming increasingly competitive. As the marketplace burgeons with new providers, so too does the number of private health insurance audit requests issued to the health practitioners who service their members. Meridian Lawyers regularly assists practitioners to respond to requests for information from private health insurers (PHIs), which has […]

Apr 16, 2020

INSIGHT: A reminder on section 130 of the National Law: notify the National Boards of ‘certain events’, or face a possible finding of unprofessional conduct

Most registered health practitioners are aware of the obligation to notify the National Board of certain events should they occur.  These requirements are set out in section 130 of the Health Practitioner Regulation National Law Act 2009 (the “National Law”).  However, we have recently seen an ‘uptick’ in the number of disciplinary decisions which have […]

Mar 25, 2020

INSIGHT: A wrongful birth case study: Nouri v Australian Capital Territory [2020] ACTCA 1

The Australian Capital Territory Court of Appeal (ACT CoA) has recently issued a decision in a wrongful birth case, exploring issues around both breach of duty and causation. Ultimately, the Court decided in favour of the hospital which provided prenatal care to the infant’s mother. The decision is an interesting one, in that although the […]

Jan 31, 2020

INSIGHT: Soutorine and The Medical Board of Australia [2020] WASAT 5

Facts Mikhail Soutorine is a medical practitioner (the practitioner).  In November 2019, the Australian Health Practitioner Regulation Agency (AHPRA) on behalf of the Medical Board of Australia (the Board) wrote to the practitioner and advised him that the Board had decided to take immediate action under section 156 of the Health Practitioner Regulation National Law […]

Oct 28, 2019

INSIGHT: Nurse slammed for profiting under patient’s will and pressuring peers

Meridian Lawyers recently published a Health Insights article discussing the risks involved when health care professionals receive and retain gifts from their patients. Since then, the Victorian Civil and Administrative Tribunal (VCAT) has issued a decision which serves to not only underscore that counsel, but also to highlight the severe reprimands which may follow findings […]

Oct 14, 2019

INSIGHT: You have received a notification – what now?

The practice of pharmacy is highly regulated and modern society is becoming increasingly litigious. With that in mind, pharmacists should anticipate that they may be contacted by a statutory authority or investigator at some stage during their careers. In 2017-18, 1.9% of pharmacists in Australia were the subject of notification to AHPRA[1]. Common statutory authorities […]

Sep 23, 2019

INSIGHT: Ask for help, and ask early – advice for surviving an AHPRA notification

Meridian Lawyers regularly assists health practitioners who have been the subject of notification to statutory health authorities such as AHPRA, HCCC and the OHO. Our role is to help these practitioners understand, respond to and navigate the complaints process.  Unfortunately, we regularly hear clients express distress that they are the subject of complaint. Many suffer […]

Jun 5, 2019

INSIGHT: Medicare Shared Debt Recovery Scheme to significantly affect recovery of incorrect Medicare billings from next month

From 1 July 2019, the Shared Debt Recovery Scheme will allow the Commonwealth Government to hold a practitioner (primary debtor) as well as another party such as medical and other health practices (secondary debtor) responsible for repayment of debts resulting from incorrectly claiming Medicare benefits. According to the recently enacted Health Insurance (Medicare Compliance Shared […]

Apr 12, 2019

INSIGHT: Police in Victoria and Western Australia, to share information with AHPRA

In July 2018 the Australian Health Practitioner Regulation Agency (AHPRA) and Victoria Police announced a Memorandum of Understanding (MOU) regarding information sharing. Under the Victorian agreement, AHPRA can disclose information to Victoria Police where there are allegations or evidence of criminal offending including physical harm, sexual offending, production of exploitative material, or drug offences. The […]

Apr 12, 2019

INSIGHT: Professional Performance under the Spotlight | Inquiry into the actions of the regulator and local health district

From 1999 onwards, Dr Emil Gayed worked in public and private hospitals across NSW. During that time, complaints and concerns were raised regarding Dr Gayed’s professional practice and performance. Dr Gayed was disqualified from practice following a Tribunal finding that Dr Gayed had engaged in numerous incidences of unsatisfactory professional conduct, and that together they […]

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