15Revocation and variation of qualifying claim certificates

15 Revocation and variation of qualifying claim certificates

Revocation (1) The Chief Executive Medicare may revoke a qualifying claim certificate if the Chief Executive Medicare is no longer satisfied as mentioned in subsection 11(1) or (2) in relation to the claim. (2) To avoid doubt, in considering whether he or she is still satisfied as mentioned in subsection 11(1) or (2) in relation to the claim, the Chief Executive Medicare may have regard to matters that have occurred since the decision to issue the qualifying claim certificate was made, including for example: (a) the making of Rules for the purpose of paragraph 11(3)(k),(l) or (m) or (4)(b); or (b) changes to the terms and conditions of the contract of insurance identified in the certificate. Variation (3) If the Chief Executive Medicare is satisfied that a matter is not correctly identified or specified in a qualifying claim certificate, the Chief Executive Medicare must vary the certificate so that it correctly identifies or specifies the matter. Effect of revocation (4) If: (a) the Chief Executive Medicare revokes a qualifying claim certificate; and (b) an amount of Level 1 or Level 2 Commonwealth contribution has already been paid in relation to the claim; the amount is an amount overpaid to which section 64 applies. Effect of variation (5) If: (a) the Chief Executive Medicare varies a qualifying claim certificate; and (b) an amount of Level 1 or Level 2 Commonwealth contribution has already been paid in relation to the claim, and that amount exceeds the amount that would have been paid if the amount of Level 1 or Level 2 Commonwealth contribution had been determined having regard to the certificate as varied; the amount of the excess is an amount overpaid to which section 64 applies. ART review of decision to revoke or vary (6) An application may be made to the Administrative Review Tribunal for review of a decision of the Chief Executive Medicare to revoke or vary a qualifying claim certificate.

Note: Section 266 of the Administrative Review Tribunal Act 2024 requires notification of a decision that is reviewable.

Chief Executive Medicare to give applicant copy of varied certificate (7) If the Chief Executive Medicare decides to vary a qualifying claim certificate, the Chief Executive Medicare must, within 28 days of making his or her decision, give the applicant a copy of the varied certificate. However, a failure to comply does not affect the validity of the decision.