Reporting incorrect billing, claiming, or suspected fraud

We protect the integrity of health programs by making sure that correct payments are made for the right services. If you think a doctor or pharmacist has charged you, or claimed for, a service or product you didn’t receive, let us know here.

What to report to us

Let us know if you think someone has claimed a Medicare or Pharmaceutical benefit incorrectly. This may include claiming for a service which was not provided, or not meeting the requirements for claiming.

The kinds of payment concerns to report to us include:

We accept tip-offs about:

  • doctors, pharmacists, dentists and allied health professionals such as physiotherapists
  • pharmacies, medical practices, hospitals and administrative staff.

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, so 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 provider. Pathology tests are claimed by the medical practitioner who reports the result, not the person who collected the sample.

What to report to someone else

There are some things we can’t investigate.

You can report these things to other authorities:

  • Reports about fake vaccine certificates – submit these to Services Australia (Proof of COVID-19 vaccinations for businesses - Running a business - Services Australia)
  • 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 (also AHPRA).
  • Suspected Medicare, pharmaceutical or Centrelink fraud by a member of the public (not a health provider or their employee) – This includes concerns about stolen Medicare cards or that you have been advised that your Medicare details have been affected by the Optus breach – submit these to Services Australia.
  • Concerns about aged care services – submit these to the Aged Care Quality and Safety Commission (ACQSC).
  • 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.
  • COVID-19 vaccination issues in pharmacies: submit these to the Pharmacy Program Administrator PPA tip-off form.

How to submit a tip-off

You don’t have to give us your details when you submit a tip-off.

But it helps if you do, so we can contact you for more information if we need it.

If you want to make a report, call our hotline.

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

Or, if you can’t call the hotline, use our tip-off form.

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