Australian Medicare Benefits

The Health Insurance Act 1973 (Cth) and Medicare Benefits Schedule regulate the Medicare benefits payable in Australia for the professional services provided by medical practitioners who are regularly required to make prompt decisions with respect to the interpretation and billing of Medicare items. If a medical practitioner engages in unacceptable practice by inappropriately billing Medicare items, subsequent professional review, disciplinary action and criminal proceedings can follow. Despite the explanatory notes provided for each Medicare item, disagreements between practitioners, professional bodies/associations and the relevant authorities can arise with respect to the meaning and scope of a particular Medicare item. This article explores the anterior question involved in resolving such disagreements, namely, what principles of statutory interpretation do the courts apply in the civil and criminal jurisdictions to determine the meaning and scope of a Medicare item.