Document ID: chunk:federal_register_of_legislation:F2021L01571:reg:8
Version: federal_register_of_legislation:F2021L01571
Segment Type: reg
Provision Reference: reg 8
Character Range: 8557–11018

8  Linkage of claims information

        (1)  Services Australia and the Department of Health (where the Department of Health is enabling the Chief Executive Medicare to perform health provider compliance functions) may only link claims information from the Medicare Benefits claims database and the Pharmaceutical Benefits claims database relating to the same individual in the following circumstances:

             (a)  for internal use that is authorised or required by law and is reasonably necessary, in a specific case or in a specific set of circumstances, for the discharge of statutory functions, duties and powers of the Chief Executive Medicare (including health provider compliance functions) in relation to:

            (i)  the enforcement of the criminal law;

            (ii) the enforcement of a law imposing a pecuniary penalty; or

            (iii)  the protection of the public revenue;

             (b)  for the purpose of external disclosure:

            (i)  where that disclosure is required by law;

                  (ii)  to an enforcement body where that disclosure is reasonably necessary, following linkage, in a specific case or in a specific set of circumstances, for:

              (a) the enforcement of the criminal law;

              (b) the enforcement of a law imposing a pecuniary penalty; or

              (c) the protection of the public revenue;

             (c)  for the purpose of determining an individual's eligibility for a benefit under one program, where eligibility for that benefit is dependent upon services provided under the other program;

             (d)  where the Chief Executive Medicare believes on reasonable grounds that the linkage is necessary to prevent or lessen a serious and imminent threat to the life or health of any individual; or

             (e)  for disclosure to an individual where that individual has given their consent.

        (2)  The discretion referred to in section 8(1) does not permit Services Australia or the Department of Health where the Department of Health is enabling the Chief Executive Medicare to perform health provider compliance functions, to establish a data matching program between the Medicare Benefits claims database and the Pharmaceutical Benefits claims database.

        (3)  Where claims information is linked pursuant to section 8(1)(b), the Medicare PIN must not be disclosed unless it is expressly required by law.