Pathology compliance

The national Health Insurance Act 1973 includes provisions for prohibited practices. The provisions include rent for Approved Collection Centres. Learn more about these provisions and how to comply with them.

About pathology rents

Approved pathology collection centres (ACCs) are often co-located with other health services, such as general practitioner (GP) clinics.

Paying rent for pathology premises, or other benefits, can breach the ‘prohibited practices provisions’ of the Health Insurance Act 1973 (Part IIBA). 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 services from a particular provider
  • being related to the business of providing a pathology service, such as charging too much or too little rent, compared to other nearby ACCs such as within the same postcode.

Why they are important

Prohibited practices prevent misuse of public funds through Medicare.

When they apply

These rules apply to any payment for the use or occupation of premises, including rent or a licence fee.

They do not apply when a lease is shared.

Learn more about which commercial arrangements are permitted (under strict rules) in the Red Book.

Who they apply to

The prohibited practices provisions apply to anyone who requests a Medicare-eligible pathology service, including:

  • general practitioners
  • medical specialists
  • dental practitioners
  • podiatrists
  • physiotherapists
  • osteopaths
  • chiropractors
  • nurse practitioners.

In some circumstances the provisions also to apply to people who are connected to a requestor or provider, such as relatives, staff or business partners.

Read more details about who is affected in the Red Book.

How to comply

The Red Book outlines our compliance and enforcement strategy. It helps both requesters and providers of pathology services to comply with the legislation.

We regularly monitor the pathology sector, including ACCs that are:

  • new
  • closed
  • updated
  • reopened.

Reporting to Services Australia

Approved Pathology Authorities (APAs) 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 (for example, a medical centre name change)
  • change of room
  • options to extend the lease.

ACCs must tell Services Australia within 30 days of acquiring or merging with an APA.

Accredited Pathology Laboratories must complete an acquisition or merger advice form if ownership of the laboratory changes.

Contact our compliance team if you need more information.

How to report non-compliance

Anyone 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 a civil penalty (Part IIBA of the Health Insurance Act 1973).

Find out how to report suspected fraud.

Managing non-compliance

Sometimes we take enforcement action against those 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 express a commitment to comply
  • legal proceedings when there is evidence of a serious breach.

Learn more about non-compliance with Medicare.

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