Bupa has been hit with a $35 million penalty after the Federal Court found the private health insurer misled thousands of policyholders, hospitals and medical practitioners about their entitlements.
9News reports that between May 2018 and August 2023, the insurer incorrectly advised members that they were not eligible for benefits for mixed-coverage treatments or claims involving uncategorised items—despite those benefits being part of their policies. The court ruled that more than 4100 affected claims were handled in a manner that was false, misleading, deceptive and unconscionable.
The errors largely involved hospital procedures where multiple treatments were performed during the same admission, or where only portions of the treatment were included under a policy. It is reported that as a result, patients, clinicians and hospitals were left out of pocket.
The Australian Competition and Consumer Commission (ACCC) launched legal action against Bupa in June. In its judgment handed down today, the Federal Court imposed the $35 million fine and ordered a five-year injunction preventing the insurer from further breaches.
ACCC Deputy Chair Catriona Lowe said the conduct was “extremely serious”, noting that many affected members faced financial strain and, in some cases, delayed or cancelled essential medical care based on incorrect advice.
“Private health insurance represents a major household cost, and consumers deserve confidence that they will receive the coverage they have paid for.”
In a statement, Bupa acknowledged the ruling and issued an apology.
“We remain deeply sorry for these errors and for the impact on our customers and their families. We have taken steps to ensure this does not happen again.”
Bupa has already repaid customers approximately $14.3 million linked to the impacted claims.
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