We’re committed to strengthening compliance for Pathology Approved Collection Centre (ACC) rents. This falls under the ‘prohibited practices provisions’ of the Health Insurance Act 1973.
The prohibited practices provisions impact anyone who can ask for or give a Medicare-eligible pathology or diagnostic imaging service.
‘Requesters’ include general practitioners, medical specialists, dental practitioners, podiatrists, physiotherapists, osteopaths, chiropractors and nurse practitioners.
Paying rent for pathology premises or other benefits can breach the ‘prohibited practices provisions’ of the Health Insurance Act 1973 (Part IIAB). These provisions include civil penalties for:
- offering, giving, asking for, or accepting a benefit
- making a threat that can cause a requestor of the pathology services to ask for them from a provider
- being related to the business of providing a pathology service.
The Red Book outlines our compliance and enforcement strategy. It is a helpful resource that can guide both requesters and providers of pathology and diagnostic imaging services towards compliance goals. See also Part IIBA of the Health Insurance Act 1973.
Reporting pathology or diagnostic imaging prohibited practices
Requestors and providers of pathology and diagnostic imaging services can tell us about non-compliant parties. You must do this within 30 days of becoming aware of the prohibited practices. This will help you avoid the contravention of a civil penalty (Part IIBA of the Health Insurance Act 1973).
You can send us the Reporting pathology or diagnostic imaging prohibited practice form. Or you can also tell us about the non-compliance, using one of the following methods:
- online form, health provider related tip-off form
- email, provider.benefits.integrity [at] health.gov.au
- call the Provider Benefits Integrity Hotline on 1800 314 808.
In line with the Pathology Rents Compliance and Enforcement Strategy (Appendix A of the The Red Book), we have been working with providers and requesters of pathology services. This is so we can understand the nature of ACC lease arrangements of concern and encourage voluntary compliance with the Health Insurance Act 1973.
We regularly monitor the pathology sector, including closed, updated, reopened and new ACC arrangements. This ensures compliance with the prohibited practice provisions in Part IIBA of the Health Insurance Act 1973.
We issue Requests for Information to both lessors and lessees of ACCs as part of our compliance activities.
Enforcement of the Prohibited Practices Provisions
We don't just rely on voluntary compliance activities. Sometimes, we take enforcement action against parties who:
- do not comply with the prohibited practice provisions
- are engaging in repeated, deliberate or systematic contravention of the prohibited practice provisions.
Enforcement actions may include:
- accepting a voluntary compliance undertaking from parties that have expressed their commitment to compliance
- legal proceedings when there is evidence of a serious breach.
Voluntary compliance undertaking
We encourage ACC lessors and APAs to comply with the prohibited practices provisions through compliance undertakings - see Part IIBA of the Health Insurance Act 1973.
Under a voluntary undertaking, a lessor or APA can make a legally binding commitment. This ensures they take steps aimed at improving compliance with the prohibited practices provisions in respect to rents and/or other benefits.
We can escalate our compliance efforts, especially where attempts to secure voluntary compliance are unsuccessful or if there is evidence of a deliberate intention to contravene the prohibited practices provisions.
Civil penalty proceedings may be commenced where we have evidence of serious non-compliance and there are reasonable grounds to do so.
For example if you make an application to the court asking for an order, the provider or requester might need to pay the Australian Government a pecuniary penalty.
We can make a referral to the Commonwealth Director of Public Prosecutions for criminal prosecution where we have reasonable grounds to, or believe that a provider or requester has committed a criminal offence.
See an example of a legal proceeding by the Chief Executive Medicare against a provider.
Approved Pathology Authority Undertaking
Part 5 of the APA Undertaking (pages 6 – 10 of the Approved Pathology Authority application, renewal or amendment form HW011) will determine the changes you will need to report.
All APAs need to ensure that the information they give is accurate and complete. You must advise us in writing within 14 days of any change in any of the particulars in applications provided for approval as an APA, APL and ACC.
A breach of the APA Undertaking may lead to several determinations, including that Medicare payments should not be payable for up to 5 years.
You must report the following changes to Services Australia :
- ACC lessor and sub-lessor details
- rent per year
- the area of premises used by the ACC, exclusively or otherwise
- change of facility name (eg medical centre name change)
- change of room
- options to extend the lease.
Make sure your supporting documents are kept up to date and provided to Services Australia. You will need to cancel your previous ACC and apply for a new one if you want to change your ACC location.
Services Australia provides more information on how to keep details updated.
For more information, contact the Pathology Collection Centres Compliance team at pathology.rents [at] health.gov.au.
- The Red Book - Guidance on Laws Relating to Pathology and Diagnostic Imaging - Prohibited Practices
- Reporting pathology or diagnostic imaging prohibited practices form
- Legislation relating to pathology
- Legislative Amendments Relating to Pathology and Diagnostic Imaging