Selia v Commonwealth of Australia [2017] FCA 7

Selia v Commonwealth of Australia [2017] FCA 7

The PSR Committee was entitled to find that Dr Selia's practice of pre-billing and billing for services provided by employed dentists under his provider number constituted 'inappropriate practice' as defined by s 82 of the Act, because such conduct is connected to the rendering or initiating of services for which Medicare benefits are claimed, is contrary to Act requirements, and would be unacceptable to the general body of dentists. The Determining Authority's repayment order and other sanctions were lawful, reasonable, and proportionate having regard to the legislative scheme, purpose of protecting the integrity of Medicare, and the findings of the PSR Committee.

Parties
Applicant: Dr George Selia; First Respondent: Commonwealth of Australia; Second Respondent: Professional Services Review Committee No 812; Third Respondent: The Determining Authority established by s 106Q of the Health Insurance Act 1973
Jurisdiction
Australia
Judgment Date
13 January 2017
Procedural Posture
Judicial Review / Final Judgment After Hearing and Submissions
Outcome
Application dismissed with costs
Legal Topics
Judicial Review, Professional Services Review Scheme, Medicare Billing, Inappropriate Practice, Dental Services, Statutory Interpretation
Administrative Law Health Law Judicial Review Professional Services Review Scheme Medicare Billing Inappropriate Practice Dental Services Statutory Interpretation

Case Brief

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Parties

Dr George Selia

Applicant

Commonwealth of Australia

First Respondent

Professional Services Review Committee No 812

Second Respondent

The Determining Authority established by s 106Q of the Health Insurance Act 1973

Third Respondent

Procedural Posture

Judicial Review / Final Judgment After Hearing and Submissions

Legal Issues

  1. 1 Whether pre-billing for dental services constitutes 'inappropriate practice' under s 82 of the Health Insurance Act 1973 (Cth)
  2. 2 Whether using an employed dentist to provide services billed under the employer dentist's provider number constitutes 'inappropriate practice'
  3. 3 Whether findings can be made about services rendered or initiated outside the statutory review period

Ratio Decidendi

The PSR Committee was entitled to find that Dr Selia's practice of pre-billing and billing for services provided by employed dentists under his provider number constituted 'inappropriate practice' as defined by s 82 of the Act, because such conduct is connected to the rendering or initiating of services for which Medicare benefits are claimed, is contrary to Act requirements, and would be unacceptable to the general body of dentists. The Determining Authority's repayment order and other sanctions were lawful, reasonable, and proportionate having regard to the legislative scheme, purpose of protecting the integrity of Medicare, and the findings of the PSR Committee.

Court Disposition

Application dismissed with costs

Orders

  • The application is dismissed.
  • The applicant is to pay the first respondent's costs as agreed or assessed.