11BComplaints and investigations

11B Complaints and investigations

(1) For the purposes of paragraph 135A(3)(b) of the Act: (a) each of the following authorities or persons is a prescribed authority or person: (i) the Australian Health Practitioner Regulation Agency; (ii) a National Board; (iii) each State or Territory Board of a National Board; (iv) the Health Care Complaints Commission of New South Wales; (v) the Office of the Health Ombudsman of Queensland; (vi) an APS employee mentioned in paragraph 11A(a); and (b) this section sets out the circumstances in which information may be provided to a prescribed authority or person and the kind of information that may be provided. Circumstances in which information may be provided (2) Information may be provided to an authority mentioned in any of subparagraphs (1)(a)(i) to (v) if: (a) a person has complained to the Chief Executive Medicare about a health practitioner; and (b) the Chief Executive Medicare reasonably believes that the complaint should be referred to the authority for possible investigation. (3) Information may be provided to an authority mentioned in any of subparagraphs (1)(a)(i) to (v) if the authority tells the Chief Executive Medicare that a person has made a complaint to the authority about a health practitioner. (4) Information may also be provided to a person mentioned in subparagraph (1)(a)(vi) in the circumstances mentioned in subsection (2) or (3). (5) Information may be provided to an authority or person mentioned in paragraph (1)(a) if a health practitioner is the subject of an investigation by the Chief Executive Medicare. (6) However, information may only be provided to a State or Territory authority under subsection (5) if: (a) the health practitioner is, was, or is applying to be, registered or licensed to practice in that State or Territory; or (b) the health practitioner is or was practising in that State or Territory. Information that may be provided (7) The following information may be provided in relation to a health practitioner who is the subject of a complaint or investigation mentioned in subsection (2), (3) or (5): (a) name; (b) the address of each location at which the health practitioner practises (including any former location at which the health practitioner practised in the period that is the subject of the complaint or investigation); (c) if the health practitioner has been allocated an identifying number by the Chief Executive Medicare or the Secretary (such as a provider number, requester number or pharmacy approval number)—the number; (d) whether the health practitioner has been the subject of an investigation by the Chief Executive Medicare, and if so, the status of the investigation. (8) Information relating to a service or to the supply of a pharmaceutical benefit or other goods may be provided if: (a) a health practitioner who is the subject of a complaint or investigation mentioned in subsection (2), (3) or (5): (i) provided the service or supplied the pharmaceutical benefit or other goods; or (ii) supervised the provision of the service or the supply of the pharmaceutical benefit or other goods; or (iii) requested the service or the supply of the pharmaceutical benefit or other goods; or (iv) claimed or received payment of fees in relation to the service or the supply of the pharmaceutical benefit or other goods; or (v) in the case of a service—was the assignee under an assignment or agreement, made or entered into in accordance with section 20A of the Health Insurance Act 1973, in relation to the medicare benefit in respect of the service; and (b) the Chief Executive Medicare reasonably believes that the service or the supply of the pharmaceutical benefit or other goods is relevant to the complaint or investigation. (9) The information mentioned in subsection (11) relating to a person may be provided if the person has made a complaint mentioned in subsection (2) or (3). (10) The information mentioned in subsection (11) relating to a person may also be provided if: (a) the person has received a service or been supplied a pharmaceutical benefit or other goods; and (b) a health practitioner who is the subject of a complaint or investigation mentioned in subsection (2), (3) or (5): (i) provided the service or supplied the pharmaceutical benefit or other goods; or (ii) supervised the provision of the service or the supply of the pharmaceutical benefit or other goods; or (iii) requested the service or the supply of the pharmaceutical benefit or other goods; or (iv) claimed or received payment of fees in relation to the service or the supply of the pharmaceutical benefit or other goods; or (v) in the case of a service—was the assignee under an assignment or agreement, made or entered into in accordance with section 20A of the Health Insurance Act 1973, in relation to the medicare benefit in respect of the service; and (c) the Chief Executive Medicare reasonably believes that the service or the supply of the pharmaceutical benefit or other goods is relevant to the complaint or investigation. (11) For the purposes of subsections (9) and (10), the information relating to the person is the following: (a) name; (b) contact information; (c) sex; (d) date of birth; (e) medicare number; (f) if the person is not a permanent Australian resident: (i) date of last entry into Australia; and (ii) expected date of departure from Australia; and (iii) name of country of residence.