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Successful Review Application Case Study

Our client was an overseas trained doctor (“OSTD”) who sought our assistance after their application for Medicare provider numbers was rejected.  Our client needed the provider numbers to gain employment as a provider of medical services at several locations in regional New South Wales.

The ability of an OSTD to obtain a Medicare provider number is restricted under s 19AB of the Health Insurance Act 1973 (Cth) (“the Act”).  However, in certain circumstances it is possible for an OSTD to obtain an exemption from the Minister for Health pursuant to s 19AB(3).

To this end, s 19AB of the Act requires the Minister to publish guidelines outlining the circumstances in which exemptions may be granted (“the Guidelines”), and also requires the Minister to comply with the Guidelines when applying the discretionary power to grant an exemption.

The Guidelines require the Minister to take into account, as a primary consideration, whether the service location is classified as a “district of workforce shortage” for the OSTD’s field of medical practice.  The Guidelines also provide that the Minister may take into account any other relevant factors.

Our client’s challenge was that none of the intended service locations were classified as a “district of workforce shortage” for our client’s field of medical practice.

Upon further investigation we discovered that our client’s prospective employer intended for our client to replace several senior medical practitioners who had been servicing different regional areas of New South Wales for many years and who were imminently going to retire.  The prospective employer had long attempted to recruit a locally trained doctor to service those areas but had been unable to do so.

In light of this further information we applied on behalf of our client, pursuant to s 19AC of the Act, for review of the Minister’s initial decision rejecting our client’s application (“the Review Application”).  We made submissions to the effect that:

  • the imminently retiring medical practitioners needed to be replaced in order to maintain the ongoing level of services in their respective regional locations;
  • if our client was unable to be employed to replace them, it would be likely that each of the locations would eventually become a “district of workforce shortage” for our client’s field of medical practice;
  • these factors were relevant to the Minister’s decision and should be taken into account despite the fact none of the areas in question were currently classified as a “district of workforce shortage”.

We had also consulted with the Minister’s delegate regarding the evidence necessary to support the Review Application and we were then able to prepare and submit the necessary evidence with the application.

The Review Application was successful and our client was granted the Medicare provider numbers.  That meant our client could be employed as intended, and that the level of servicing in those regional areas of New South Wales would be maintained.

names withheld for reasons of confidentiality