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?
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:
- completing our reporting suspect fraud form
- completing our health provider fraud tip-off form
- calling our fraud hotline – 1800 829 403
- writing to us
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.
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