We are serious about preventing, detecting, and countering fraud and corruption. It is vital that the public has confidence in the integrity of our people and the programs we deliver for Australians.
Fraud and Corruption Control Plan 2023–25
What fraud is
Fraud occurs when someone acts in a dishonest or deceiving way to gain a benefit.
Broadly, fraud can include:
- theft
- misuse of funding
- falsifying documents
- impersonating public officials
- misusing information
- a public official taking advantage of their position.
For specific examples, see what we investigate.
Why report fraud
We encourage you to report suspected fraud. By making a report, you can help us to keep our health and aged care system fair for everyone. Fraud adds to the cost of programs and services that taxpayers pay for.
What we investigate
We, the Department of Health and Aged Care, are responsible for investigating:
- fraud against aged care programs
- fraud or non-compliance by health providers who receive payments under Medicare
- fraud against other health programs or by our staff.
Find out what fraud you might need to report to someone else.
Suspected fraud against aged care programs
We accept reports of suspected fraud relating to the aged care programs and services we fund including:
- care in your home, including
- residential care in aged care (nursing) homes
- short-term care, including after-hospital and respite care
- flexible care, including the
You can report suspected fraudulent activity about anyone involved in providing or receiving services under aged care programs including:
- aged care providers
- third parties delivering aged care services, including subcontractors
- older people receiving services, or their representatives.
We do not investigate concerns about the safety or quality of aged care services. Report these to Services Australia. Find out what other fraud you might need to report to someone else.
Examples of fraud against aged care programs
Examples of fraud against aged care programs include:
- where an older person has been billed for an aged care service that was not provided
- where an older person or their representative misuses aged care funds to purchase items not allowed under the relevant program.
See how to report suspected fraud.
Suspected or fraud by health providers who receive payments under Medicare
We accept reports of suspected non-compliance or fraud by health providers when they obtain payments under Medicare, including:
- Medicare benefits via the Medicare Benefits Schedule
- Pharmaceutical benefits via the Pharmaceutical Benefits Scheme
- benefits via the Child Dental Benefits Schedule
- payments and incentives including the:
- COVID-19 vaccination issues related to the charging of out of pocket costs, or the billing of additional Medicare items in general practice
- charging for COVID-19 vaccinations by general practices.
Find out what fraud you might need to report to someone else.
Examples of health providers
Health providers include:
- doctors, pharmacists, dentists and allied health professionals such as physiotherapists
- pharmacies, medical practices, hospitals and administrative staff.
Examples of non-compliance or fraud by health providers
Examples of health provider non-compliance or fraud may include:
- prescribing or dispensing medicines not as intended
- billing (charging) inappropriately for services – such as where a doctor has billed you for a service when you have not attended their practice
- claiming for services not provided – such as where a doctor has billed for a different service than was provided or a pharmacist has claimed for an item not supplied.
If you see a name you don't know on your Medicare statement
Your Medicare statement includes a list of Medicare services which have been claimed, and the practitioner who claimed the service.
Most of us recognise our doctor’s name, but it’s not unusual to be concerned if you see a name you don’t recognise on your Medicare statement.
If this happens, consider whether you might have had a service, such as an eye test, pathology, or diagnostic imaging, from someone other than your usual doctor or health provider. Pathology tests and diagnostic image requests are claimed by the medical practitioner who reports the result, not the person who collected the sample.
If you still have concerns, see how to report suspected non-compliance or fraud.
Suspected fraud against other health programs or by our staff
We accept reports of suspected fraud against other health programs we fund including:
- health services such as hearing services, mental health services and Indigenous health
- grants that we fund
- vaccination programs such as the
- COVID-19 vaccination program (except for vaccinations done in a pharmacy – report these to the Pharmacy Program Administrator PPA tip-off form)
- National Immunisation Program.
We also accept reports of suspected fraud against our staff. We have zero tolerance to fraud or corruption by our employees or contractors, in any area of our work.
Find out what fraud you might need to report to someone else.
Examples of suspected fraud against health programs or our staff
- fraud against other programs or grants may include
- providing services not as intended
- misuse of grant funding provided by us
- providing misleading information to receive a grant or payment
- using the funding for different purposes than it was meant for
- fraud or corruption by our staff may include
- seeking, giving or taking bribes
- a serious conflict of interest
- manipulating recruitment, procurement or grant processes
- seeking gifts, entertainment or anything else of value from people providing goods or services to the department
- improperly disclosing government information to benefit them or someone else.
See how to report suspected fraud.
Alternatively, if you are a current or former public official, you can raise your concerns through a Public Interest Disclosure direct to an authorised officer.
What to report to someone else
There are some things we can’t investigate.
You can report these things to other authorities:
- Reports about patient safety or harm – submit these to the Australian Health Practitioner Regulation Agency (Ahpra).
- Rude, racist, inappropriate professional conduct, not listening, dismissive service quality or interaction issues– submit these to Ahpra.
- Suspected Medicare, pharmaceutical, COVID-19 economic support payments or Centrelink fraud by a member of the public (not a health provider or their employee) – submit these to Services Australia.
- Concerns about the safety or quality of aged care services – submit these to the Aged Care Quality and Safety Commission.
- Medicine on-selling by a member of the public – contact your state police.
- Claims made to your private health insurer – report to your own health insurance fund.
- Counterfeit (fake) medicines or medical devices – report these to the Therapeutic Goods Administration.
- Concerns relating to programs or funding administered by states and territories – contact the health department in your state or territory.
- Concerns relating to programs or funding administered by other government departments or agencies – contact the relevant department or agency directly.
More information about fraud and how to report fraud others investigate is available on the Commonwealth Fraud Prevention Centre website.
When to report suspected fraud
You can report suspected fraud, including non-compliance or corruption, at any time, but sooner is usually better.
Who can report suspected fraud
Anyone can report suspected fraud or corruption. You can remain anonymous if you prefer. However, providing your details means we can contact you if we need more information.
How to report suspected fraud
Online form
Other ways to report suspected fraud
You can also:
- call us
- email us
- write to us.
Contacts
Report fraud or corruption by our staff
Report health provider fraud against health programs
Report suspected fraud against aged care programs
How we protect your privacy
When you report suspected non-compliance or fraud, your personal information is protected by law, including the Privacy Act 1988.
What we do when you send us a report
We take all reports of suspected fraud and corruption seriously and investigate when we have enough information. We:
- treat all information securely, sensitively and confidentially
- log and assess all reports
- provide limited feedback for privacy and so ongoing investigations are not jeopardised
- don’t comment on investigations into individual providers or their staff due to the secrecy provisions of the Health Insurance Act 1973
- may refer the matter to the Commonwealth Director of Public Prosecutions and also, in some circumstances, to the Australian Federal Police and state police.
Penalties for committing fraud
Fraud perpetrated against the Commonwealth is prosecuted to protect resources for the benefit of all Australians.
The maximum penalty for:
- an offence against section 134.2(1) of the Criminal Code is 10 years’ imprisonment
- offences against sections 135.1(1), 135.1(3) and 135.1(5) of the Criminal Code is 10 years’ imprisonment.