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’.
Fraud is defined as dishonestly obtaining a benefit or causing a loss by deception or other means.
Why report fraud?
The Australian Government is committed to preventing fraud against its programs and services. The Commission is serious about preventing, detecting and dealing with fraud against the agency and the aged care sector.
If you suspect someone may be committing fraud against the Commission, the health system or the aged care sector you should report it.
What you have noticed may not be fraud, but we are still interested.
We acknowledge that there are a range of behaviours that may seem suspicious, and that some of these might not be fraudulent, they might be mistakes or a misunderstanding – even if a mistake has been made, we need to hear about it so we can fix it.
We encourage you to report suspicious behaviour. Reports can be made anonymously and your rights are protected by law. 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.
Personal information is collected by the Commission in the course of conducting fraud investigations, assessments and other fraud control activities. The primary purpose of this collection is for the prevention, detection and response to fraud against the Commission and the Commonwealth.
What fraud we investigate
We are responsible for investigating suspected fraud or corruption by:
- activities funded by the Commission, such as services, grants and other payments
- our staff
The Commission works collaboratively with the Department of Health on matters relating to fraud.
Department of Health investigations
The Department of Health will investigate suspected fraud or corruption by:
- health providers
- aged care providers
- activities funded by the Department of Health, such as services, grants and other payments
- their staff
Suspected fraud by health providers
Anyone can report suspected fraud by health providers. Any information that you can provide is valuable.
You can find more information on the Department of Health website
Suspected fraud or corruption by our staff
The Commission will not tolerate 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
- misuse of Commission-held information
- corruption, misconduct and abuse of power
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 Commission.
What fraud we don’t investigate
Fraud by the general public
Fraud by the general public can include claiming and receiving Medicare, 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 Services Australia, the Department of Health or the Australian Federal Police.
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
Report health professionals
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.
If you have concerns, but do not want to report them to the Commission, you may wish to report your concerns by calling:
- Australian Competition and Consumer Commission – 1300 302 502
- Commonwealth Ombudsman – 1300 362 072
- Australian Human Rights Commission – 1300 656 419
How to report fraud
You can call our fraud hotline on 02 7809 9900 to report suspected fraud or corruption.
A fraud investigator will return your call in order to gather additional information. You are able to remain anonymous, however providing your contact details will assist with any potential investigation.
Fraud Control Officer
GPO Box 9819
Canberra ACT 2601
Public interest disclosure
If you wish to make a Public Interest Disclosure, please call 1800 951 822.
Report health provider fraud against health programs
You can report suspected fraud by health providers against health programs:
Provider Benefits Integrity Hotline
Provider Benefits Integrity Tip-Offs
MDP 659 GPO Box 9848
Canberra ACT 2601
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.