Rent or other benefits may, in certain circumstances, breach the prohibited practices provisions of the Health Insurance Act 1973 . Those provisions prohibit the offer or acceptance of benefits that would be reasonably likely to induce a requester of pathology services to request those services from a provider.
The Department has consulted with stakeholders and has revised the Red Book, providing guidance on the prohibited practices provisions, to ensure it meets contemporary needs.
The revised Red Book provides guidance on how the laws affect both requesters and providers of pathology and diagnostic imaging services, and outlines the Department’s compliance and enforcement strategy. This includes a timeline with examples which demonstrate the compliance activities the Department may undertake to enforce the prohibited practices provisions as they relate to ACCs.
It is very important to understand that the prohibited practices provisions affect anyone who can request or provide a Medicare-eligible pathology or diagnostic imaging services. Requesters include general practitioners, medical specialists, dental practitioners, podiatrists, physiotherapists, osteopaths, chiropractors and nurse practitioners.
The Department has established a contact line where concerns relating to suspected breaches of the prohibited practices provisions can be reported by
- submitting an online Health provider related tip-off form
- emailing firstname.lastname@example.org
- calling the Provider Benefits Integrity Hotline 1800 314 808
Reporting pathology or diagnostic imaging prohibited practice(s)
If you are a requester or provider of pathology or diagnostic imaging services and you have knowledge that another person has asked for or accepted or offered or provided a prohibited benefit, or made a threat, you can report this to the Department, within 30 days of becoming aware of these practices through the 'Reporting pathology or diagnostic imaging prohibited practice(s) form'.
PDF version: The Red Book - Guidance on Laws Relating to Pathology and Diagnostic Imaging - Prohibited Practices (PDF 1.2 GB)
Word version: The Red Book - Guidance on Laws Relating to Pathology and Diagnostic Imaging - Prohibited Practices (Word 494 KB)
Reporting pathology or diagnostic imaging prohibited practice(s) form (Fillable PDF)
Frequently Asked Questions and Answers
Legislation relating to Pathology
Legislative Amendments Relating to Pathology and Diagnostic Imaging