Document ID: chunk:federal_register_of_legislation:F2024C00800:reg:18:p33
Version: federal_register_of_legislation:F2024C00800
Segment Type: reg
Provision Reference: reg 18 (pt 33/42)
Character Range: 239470–242225

given where the entitled person:

(a) is a stretcher case; or

(b) requires treatment during transport; or

(c) is grossly disfigured; or

(d) is incontinent to a degree that precludes the use of other forms of transport.

12.1.3 Other than in exceptional circumstances, air ambulance will be approved only to transport an entitled person with acute medical and surgical complaints for admission to, or discharge from, a hospital.

12.1.4 The Commission will accept financial responsibility for the use of ambulance transport in a medical emergency for an entitled person if an office of the Department is notified on the first working day after the ambulance transport is used or as soon thereafter as is reasonably practicable.

12.1.5 Prior approval for ambulance transport for entitled persons is not required where the transport is provided under arrangements between the ambulance service provider and the Commission.

12.2  Treatment under Medicare Program
12.2.1 Entitled persons may choose to have their treatment arranged through the Department or under a medicare program.
12.2.2 Subject to these Principles, entitled persons who are treated under a medicare program may also receive services that are not covered by the MBS at the Commission's expense.

12.2.3 When part or all of the cost of a treatment item has been paid as a medicare benefit, the Commission will not pay for the same professional or ancillary service regardless of the person's entitlement under the Act.

12.4 Prejudicial or unsafe acts or omissions by patients
12.4.1 The Commission may refuse to be financially responsible for, or provide treatment to, or any further treatment to, an entitled person who, by an act or omission, deliberately prejudices his or her own, or a fellow patient's, treatment or the safety of persons providing treatment.

12.6 Recovery of moneys
12.6.1 Where a payment has been made to any person or body, purportedly as payment for treatment, the Commission may recover (up to the extent that the payment exceeds the amount, if any, that should have been paid to that person or body) any moneys, the payment of which was induced or affected at all by:

(a) any misrepresentation; or

(b) any mistake of fact; or

(c) any mistake of law; or

(d) any other cause.

12.6.2 Further to paragraph 12.6.1, the Commission may recover moneys for any excess amounts that should not have been paid to that person or body:

(a) in a single demand; or

(b) by instalments; or

         (c) subject to section 317 of the Act, by offsetting moneys for any excess amounts against any later claims for payment by that person or body; or
Note: Section 317 provides, in effect, that where amounts have been overpaid, the Commission may, if the person agrees,