A fake doctor who worked for more than a decade in Sydney and on the Central Coast is believed to have fled the country.
Shyam Acharya allegedly used another person's name and medical qualifications to become registered in New South Wales.
He worked at Manly, Hornsby, Wyong and Gosford hospitals from 2003 to 2014 after assuming the identity of doctor Sarang Chitale.
Acharya allegedly stole documents while living in India and used them to register with the Medical Board of NSW, the NSW Health deputy secretary Karen Crawshaw revealed yesterday.
Acharya has been charged by Australian Health Practitioner Regulation Agency and faces being fined up to A$30,000.
However, it's not clear if he will face court because it's believed he is overseas, Health Minister Brad Hazzard said today.
It was "disturbing" Acharya got through border protection with a false passport after assuming the identity of a doctor in India, Hazzard said.
He will raise the issue at this month's COAG Health Minister's meeting to ensure checks and balances are in place at a national level so the ruse can't be repeated.
"The Ministry of Health has advised me there have been substantial changes since 2003 in the checks that are made, but I want health to revisit the issue and make absolutely certain that the new federal registration process operating since 2011 is as scrupulous as can be," Hazzard said.
"I have also directed the Ministry of Health to look at every aspect of registration to make sure that NSW Health has done whatever it can to look beyond fake passports with particular reference to going back to primary documents from country of origin."
Hazzard says the fine is "crackers". "I will be pushing for a jail term for anybody who thinks this is acceptable," he said.
AMA NSW president, Professor Brad Frankum told AAP it was "a worry (Acharya) was able to fool the system for so long".
"It was a long time ago that the person faked their way in ... and the system is more robust now than it was."
Frankum said the accreditation process from medical colleges today was very rigorous for doctors from overseas.
"There is a requirement now for a verbal referee check from somebody who has worked with the individual overseas which wasn't in place back in 2003," he said.
NSW Health would not say whether Acharya had any medical experience before working in Australia, but his status as a junior doctor with limited registration meant he was subject to supervision, Crawshaw said.
Acharya was involved in one critical incident where there were concerns about a patient's treatment, but only as one of several people on the clinical team.
NSW Health received no further complaints about the doctor.
Australia's Health Practitioner Regulation Agency advised NSW Health it was investigating Acharya in 2016 - more than two years after he left the state's public health system.
He has since been charged with a breach of the Health Practitioner Regulation National Law.