27Prescribed authorities and persons for the purposes of subsection 130(3A) of the Act

#### 27 Prescribed authorities and persons for the purposes of subsection 130(3A) of the Act (1) For the purposes of subsection 130(3A) of the Act: (a) a person holding an office specified in column 2 of an item in Part 2 or 3 of Schedule 3 is a prescribed person; and (b) information may be provided to a person holding an office specified in column 2 of an item in Part 2 or 3 of Schedule 3, being information: (i) of the kind indicated in column 3 of that item; (ii) for the purpose of checking whether: (A) a claim in respect of the same service has been made on both the Department of Veterans’ Affairs and the Chief Executive Medicare; or (B) a claim that should have been made on the Chief Executive Medicare has been made on that Department; or (C) a claim that should have been made on that Department has been made on the Chief Executive Medicare; or (D) a claim that has been either paid or rejected by the Chief Executive Medicare has been made on that Department. (2) For purposes of subsection 130(3A) of the Act: (a) an authority specified in Part 4 of Schedule 3 is a prescribed authority; and (b) a person specified in that Part is a prescribed person; and (c) an authority of a State or Territory specified in Part 5 of that Schedule is a prescribed authority. (3) For the purposes of subsection 130(3A) of the Act, if: (a) a patient has complained to the Chief Executive Medicare about a medical practitioner and the Chief Executive Medicare, on reasonable grounds, considers that that complaint could be the subject of an investigation by a Medical Board or the Complaints Unit; or (b) the Chief Executive Medicare believes, on reasonable grounds, that a patient has complained to a Medical Board or to the Complaints Unit about such a practitioner; or (c) a patient has received a service from such a practitioner who is the subject of an investigation by the Chief Executive Medicare, a Medical Board or the Complaints Unit; the kind of information that may be made available to a person from time to time holding, occupying or performing the duties of an office specified in Part 2 or 3 of Schedule 3 or an authority, or a person, referred to in subregulation (2) is: (d) in relation to the patient—the information specified in subregulation (5); and (e) in relation to the practitioner—the information specified in subregulation (7). (4) Information relating to a practitioner, or to a patient of a practitioner, may not be made available to an authority, or to a person, specified in Part 4 or 5 of Schedule 3 unless: (a) the authority is a prescribed authority; or (b) the person is a prescribed person; of the State or Territory: (c) in relation to which the practitioner: (i) is registered or licensed; or (ii) was registered or licensed; or (iii) is applying to be registered or licensed; to practice as a medical practitioner; or (d) in which the practitioner is or was practising. (5) For the purposes of subregulation (3), the information relating to the patient is: (a) name including any former name; and (b) residential address including postcode and, if the patient’s postal address is another address, that other address including postcode; and (c) residential telephone number; and (d) work telephone number; and (e) whether male or female; and (f) date of birth; and (g) medicare card number; and (h) if the patient is not a permanent Australian resident: (i) date of last entry into Australia; (ii) expected date of departure from Australia; (iii) name of country of residence. (6) If: (a) the information specified in subregulation (5) in relation to a patient may be made available to an authority or person in accordance with subregulation (3); and (b) the Chief Executive Medicare, on reasonable grounds, considers that a claim by the patient for medicare benefits is relevant to an investigation; the Chief Executive Medicare may also permit the following information relating to that claim to be made available to that authority or person: (c) date on which that treatment was given; and (d) item number for that treatment; and (e) name and provider number of the provider giving that treatment; and (f) name and provider number of the provider nominated by the servicing provider as the person to whom payment for those services should be directed; and (g) date marked on the patient’s claim form as the date of that claim; and (h) date on which that form was lodged with the Chief Executive Medicare. (7) For the purposes of subregulation (3), the information relating to the practitioner is: (a) name; and (b) in respect of the practitioner’s practice or, if the practitioner has more than one practice, in respect of each practice: (i) address including postcode; and (ii) provider number; and (iii) date on which it was opened; and (iv) date (if any) on which it was closed; and (c) particulars of claims for medicare benefits lodged by the practitioner that the Chief Executive Medicare, on reasonable grounds, considers are relevant to the investigation. (8) For the purposes of subregulation (7), if a practitioner has a practice at more than one location, each of those locations is to be regarded as a separate practice.