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Report suspected fraud

Find out what kinds of suspected health fraud should be reported and how to report it. Learn how we protect your privacy and investigate reported fraud.

What is fraud?

Fraud occurs when someone acts in a dishonest or deceiving way to gain a benefit.

The Australian Government defines it as ‘dishonestly obtaining a benefit, or causing a loss, by deception or other means’.

Why report fraud?

We encourage you to report suspected fraud. By making a report, you can help us to keep our health system fair for everyone. Fraud adds to the cost of programs and services that taxpayers pay for.

Reporting suspected fraud doesn’t take long. We encourage you to provide as much information as you can. Even a small amount of information can help.

Who can report fraud?

Anyone can report fraud. You don’t have to give your name when making a report if you would prefer. You can remain anonymous.

How will we protect your privacy?

Your personal information is protected by law, including the Privacy Act 1988. Find out more about how we collect and use information on our privacy page.

What fraud we investigate

We are responsible for investigating suspected fraud or corruption by:

  • health providers
  • activities funded by Health, such as services, grants and other payments
  • our staff

Suspected fraud by health providers

Health providers are:

  • service providers (such as medical practices and hospitals) and their employees
  • health professionals (such as doctors, pharmacists and dentists) and their employees

Fraud by health providers may include claiming for services or products that weren't provided, and receiving payments that they're not entitled to.

Anyone can report suspected fraud by health providers. Any information that you can provide is valuable.

Suspected fraud against activities funded by Health

Activities funded by Health may include:

  • aged care services
  • hearing services
  • mental health services

Health also funds activities through grants and other payments. 

Fraud against these activities may include:

  • providing misleading information to receive a grant or payment
  • using Health funding for different purposes than it was meant for

Anyone can report suspected fraud against activities funded by Health. Any information that you can provide is valuable.

Suspected fraud or corruption by our staff

Health has zero tolerance to fraud or corruption by our employees or contractors, in any area of our work.

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

If you suspect our employees or contractors have not acted appropriately, you can report fraud or corruption by our staff.

If you're a current or former public official, you can also choose to make a public interest disclosure about suspected wrongdoing in the department.

What fraud we don’t investigate

Fraud by the general public

Fraud by the general public can include claiming and receiving Medicare, child support or welfare benefits they are not eligible for.

If you suspect a member of the public is committing these types of fraud, you can report it to the Department of Human Services.

Unethical or unsafe behaviour by health professionals

Unethical or unsafe behaviour by health professionals may include:

  • poor treatment, such as wrong or inadequate diagnosis or treatment
  • not giving enough information – for example, about a diagnosis or treatment
  • inappropriate behaviour or relationship, such as a sexual relationship between a doctor and patient
  • a doctor working under the influence of drugs or alcohol

If you want to report a health professional’s unethical or unsafe behaviour, you can make a complaint to the Australian Health Practitioner Regulation Agency.

How to report fraud

You can report suspected fraud or corruption by:

Fraud hotline

Our hotline is open 9am to 5pm Australian Eastern Standard Time, Monday to Friday.

Fraud hotline
Postal addresses: 
Fraud Control Officer
MDP 516 GPO Box 9848
Canberra ACT 2601

View contact

Report health provider fraud against health programs

Report suspected fraud by health providers against health programs. Our hotline is open 9am to 5pm Australian Eastern Standard Time, Monday to Friday.

Provider Benefits Integrity Hotline

View contact

How we investigate suspected fraud or corruption

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
  • refer the matter to the Commonwealth Director of Public Prosecutions (CDPP) and also the Australian Federal Police and State Police in some circumstances

 

Last updated: 
7 August 2019

If you would like a response please use the enquiries form instead.