Fraud Awareness

The Federal Government requires all health funds to incorporate a program of fraud control as part of overall risk management strategy. Our objective is to minimise loss from fraud so that we can maximise the amount available for benefit payments to you.

What kind of fraud are we talking about?
Our claims analysis, audits and investigations show that a small number of providers intentionally bill for services that were not provided to our members.

What do we do about it?
Licensed investigators are employed to investigate suspected instances of fraud. Our aim is to recover any money and, more importantly, deter further fraudulent behaviour.

How can members help?
The easiest way to help is to simply be aware of what you are being billed for. Make sure the dates of service are correct and that you received the treatment recorded. It is also important to treat your membership card like a credit card, and not to leave it with any provider. If your card is lost, please report it to us straight away.

Report fraud
If you have reason to suspect fraudulent activity, please call the fund on 134 246 or email us. You can choose to remain anonymous but please be assured that we follow high standards of investigative practice and always protect the interests of all parties.

Members can also contact the Private Health Insurance Ombudsman on 1800 640 695, an independent body formed to help resolve complaints.