Bupa Health Insurance Australia has been fined $35m by the Australian Federal Court for breaches of Australian Consumer Law.
Most of the claims affected by Bupa’s conduct were for hospital treatment in which two or more procedures were performed at the same time.
In cases where part of the treatment was covered by a member’s policy and part of the treatment was not covered, Bupa incorrectly rejected the entire claim, said the Australian Competition and Consumer Commission (ACCC).
The breaches took place between May 2018 and August 2023.
The ACCC said Bupa had engaged in “unconscionable conduct and making false or misleading representations to Bupa members, hospitals and medical providers about the members’ entitlements to private health insurance benefits for certain claims”.
The court said Bupa engaged in misleading or deceptive conduct and made false or misleading representations by advising that members were not entitled to benefits for any part of their claim when, in fact, these members were entitled to benefits for any treatment covered under their policy.
Bupa Australia said that as of 5 November it had already paid compensation of $14.3m to customers affected and it accepted the federal court’s decision while cooperating fully with the ACCC throughout this process.
“We remain deeply sorry for these errors and have apologised to our affected customers for the impact this has had on them and their families and have taken actions to ensure this doesn’t occur again,” said Bupa.
