35CIdentification numbers—lifting suspensions

35C Identification numbers—lifting suspensions

(1) This section applies if the allocation of an identification number to a person for a place of practice is suspended. Lifting suspensions—mandatory rule (2) Subject to subsections (6) to (8), if: (a) the person is covered by section 35 (see subsection 35(1)); and (b) the person applies to the Chief Executive Medicare to lift the suspension; and (c) if the application is made using the HPOS system: (i) the application is a compliant online application; and (ii) the application does not require additional verification (see subsection (3) of this section); and (d) if the application is not made using the HPOS system: (i) the application is a compliant manual application; and (ii) if the Chief Executive Medicare has requested, in writing, that the person give the Chief Executive Medicare specified additional information or documents in connection with the application—the person has complied with the request; then the Chief Executive Medicare must lift the suspension, with effect from the default resumption day in relation to the person’s application (see subsection (4) of this section).

Note: For HPOS system, see section 5. For compliant online application and compliant manual application, see section 35A.

(3) For the purposes of subparagraph (2)(c)(ii), an application made using the HPOS system requires additional verification if: (a) the HPOS system requires one or more documents to accompany the application; or (b) the Chief Executive Medicare has requested, in writing, that the person give the Chief Executive Medicare specified additional information or documents in connection with the application. (4) For the purposes of this section, the default resumption day in relation to an application to lift a suspension is the following: (a) for an application that is made using the HPOS system: (i) if the application specifies a day on which the lifting of the suspension should take effect, and that day is after the day on which the application is made—the day specified in the application; or (ii) otherwise—the day on which the application is made; (b) for an application that is not made using the HPOS system: (i) if the application specifies a day on which the lifting of the suspension should take effect (whether that day is the day on which the application is made or an earlier or later day)—the day specified in the application; or (ii) otherwise—the day on which the application is made. Lifting suspensions—discretions (5) If: (a) the conditions in paragraphs (2)(a) and (b) are met; and (b) the conditions in paragraph (2)(c) or (d) (whichever applies) are not met; then the Chief Executive Medicare may, if the Chief Executive Medicare is satisfied (having regard to the allocation considerations) that it would be appropriate to do so, lift the suspension, with effect from the default resumption day in relation to the person’s application. (6) If: (a) the conditions in paragraphs (2)(a) to (d) (to the extent that they apply) are all met; and (b) the person is ineligible for benefits at the place of practice on the default resumption day in relation to the person’s application; then the Chief Executive Medicare may refuse to lift the suspension. (7) If: (a) the conditions in paragraphs (2)(a) and (b) are met (whether or not the conditions in paragraph (2)(c) or (d) (whichever applies) are met); and (b) the person is ineligible for benefits at the place of practice on the default resumption day in relation to the person’s application; and (c) there is an identifiable day (being a day after the default resumption day) on which the person will no longer be ineligible for benefits at the place of practice; then the Chief Executive Medicare may lift the suspension with effect from the earliest such identifiable day. (8) If: (a) the conditions in paragraphs (2)(a) to (d) (to the extent that they apply) are all met; and (b) information included in, or documents accompanying, the person’s application to lift the suspension, or information or documents given by the person to the Chief Executive Medicare in connection with that application, are false or misleading in a material respect; then the Chief Executive Medicare may refuse to lift the suspension. (9) To avoid doubt: (a) subsections (5) to (8) do not impose any obligation on the Chief Executive Medicare to consider whether to exercise the discretions of the Chief Executive Medicare under those subsections; and (b) if the Chief Executive Medicare does not consider whether to exercise the discretion of the Chief Executive Medicare under one of those subsections, then that subsection does not apply in relation to the suspension.