Avant Insurance

Issue no. 3 - Your Legal Defence Issue

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19 Page Managing the case In this case, our medical advisors and claims managers liaised with our solicitors and engaged Medicare in discussion. Our experience and knowledge of Medicare matters was extremely useful in the case. In the end, our legal position was vindicated and many thousands of dollars were saved for members who were legitimately defending allegations made by Medicare. We regularly assist members involved in Medicare queries and investigations. Our involvement can make a considerable difference to whether a member has to pay back Medicare at all or the pay back may be significantly reduced. We advise many members on how to better use the Medicare system to avoid complaints, which can be quite complicated. Dr David Pakchung is Head of Claims in Queensland and managed the claim of one of the doctors in the case from 2007. He has combined legal and medical practice for over 20 years. The court acknowledged that the result of finding the appointments invalid might be that many decisions or reviews would be invalid but said this was "simply the product of the scale of the breaches of Ministers' statutory obligations over a considerable period". The decision gave rise to the possibility that many of the doctors who had been the subject of findings of "inappropriate practice" in that time might challenge the findings. They could seek the return of millions of dollars they had repaid to the Commonwealth over the years on the basis that the PSR Panel members on their case were also not lawfully appointed. 19 Issue 03 Legal Defence avant.org.au/publications The Minister for Health successfully applied for leave to appeal the decision to the High Court but, before the case was heard, the appeal was discontinued when the government introduced a Bill to Parliament. This amended the law to validate retrospectively all the impugned appointments and preserve the decisions made by any improperly appointed PSR Panel members. The Bill allowed the Director of PSR to re- refer our members to new PSR Committees but the Director chose not to do so. I would like to again thank Avant for its strong support, given the very daunting task of taking legal action against the Commonwealth Government." Dr Condoleon " Seek appropriate assistance as early as possible in Medicare cases. There can be legal consequences from a decision-maker's actions which go beyond the merits of the decision and the facts before them. Opportunities to develop legal arguments about the fairness of process can be lost if not taken up early enough. Key lessons For further information Avant Risk IQ Webinar Dial M for Medicare avant.org.au/risk/iq

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