Fraud isn't about people making honest mistakes. Fraud is a calculated attempt to get things that you wouldn't otherwise be entitled to from the health system.
This affects all of our 3.8 million members by undermining systems and pushing up costs. We take fraud very seriously, whether it's by members or by treatment providers, like hospitals, doctors or other practitioners.
What does fraud look like ?
Fraud has many forms. Health insurance fraud could happen through claiming for treatment or services that haven't been provided, using someone else's Medibank card, or providing false information or documents. Fraud through claim abuse can be carried out by individuals, or by groups working together.
Member fraud can mean:
Making a claim for something that hasn’t been provided.
Claiming a benefit you’re not entitled to.
Using a fake name to get a membership or claim benefits.
Provider fraud can mean:
Invoicing for different item numbers for financial gain.
Charging members for something that isn’t clinically necessary.
Claiming benefits for something done by a different provider.
Claiming for services or products that weren’t provided.
How does Medibank combat fraud?
Our investigations team detect fraud in a number of ways, from using sophisticated technology to identify unlikely treatment patterns to training our staff to spot suspicious behaviour. We target fraud through claims verification, focused intelligence and formal investigations.
How can members help?
Keep your membership card safe and your information confidential.
Check that you have been billed correctly and for the right item numbers.
Tell us immediately if you see anything suspicious in your claims history.
Make a report to tell us about anything suspicious.
How can providers help?
Make sure you’re using the right item numbers on every claim.
Let us know if anyone tries to make improper claims for benefits.
Remember that you’re personally responsible for claims using your provider number.
Properly train staff in making claims and using your provider number.
Make a report to tell us about suspicious behaviour.
Making a suspicious activity report
We know that making a report can feel a bit scary, but you’re doing the right thing for all of
our members. If confidentiality is a concern, you don’t even need to give us your name. The
more information you can give us, the more likely we’ll be able to do something to prevent
Report suspicious activity to Medibank
Thank you for helping us to investigate suspicious behaviour.
By making a report you’re doing the right thing for all of our members. The more you’re able
to tell us, the more likely we’ll be able to act on your information.
and the Privacy Act.
Fill in the form below or get in touch by calling our dedicated line 1300 110
086. We are open on Sundays.
In providing your telephone number, you consent to Medibank contacting
you about health insurance.
We'll have someone call you soon to help with any questions you have.
Or, check out our FAQs and guides to help get you started.
COVID-19 Health Assist - Expression of interest
Complete this form to express your interest in one of our programs.
If you're eligible, a member of our team will call you within 2-3 business days.
What program are you interested in?
Sorry, only members with current
Hospital cover are eligible to participate in these programs
Eligible Medibank members with Extras cover are able to access a
range of telehealth services included on their cover -
you can find out more here.
Alternatively, if you would like to talk to one of our team about your cover,
we're here on 132 331.
Your membership details
Please provide your details so we can know how to contact you.
Your contact details
By clicking Submit, I understand that Medibank or its subsidiaries may contact me to discuss
my eligibility for the Covid-19 Heath Assist program(s), and will disclose my personal
information within the Medibank Group of companies and to third party service providers.
my personal information, and how to contact Medibank: https://www.medibank.com.au/privacy/
Thank you for expressing your interest in one of our COVID-19 Health Assist programs.
If you are eligible, one of our health professionals will call you in 2-3 business days to
discuss your situation and help to enrol you in the relevant program.
There is no cost to participate, however some referred services may incur an out of pocket cost.