Health insurance fraud and inappropriate claiming occurs when someone obtains a benefit payment using false information.
Insurance fraud is a serious criminal offence, and CBHS has a no-tolerance policy for inappropriate claiming. We invite members to contact us if you have noticed any suspicious activity on your membership.
Insurance fraud has a detrimental impact for both the fund and members. Every case of fraudulent claiming contributes to costs for the health fund, which usually results in higher premiums for members. We are committed to giving our members lower than industry-average premiums, and we want to continue providing simple and fast claiming processes for members.
Examples of fraud
Insurance fraud can originate in a provider’s office, from the people covered by a membership package or from the health fund.
Examples of insurance fraud include:
- Inaccurate recording of treatments, services or procedures to maximise the provider’s payment.
- An agreement between a member and a provider to claim fraudulently.
- Claiming for services or treatments that were not provided.
- Altered receipts and claims.
- Allowing a non-member to use your CBHS membership card.
How to reduce the risk of fraud
There are steps that our CBHS members can take to reduce the risk of fraud and inappropriate claims.
- Keep your CBHS membership card secure and never leave it with a provider. Treat your membership card as you would a credit card.
- Carefully review accounts and receipts before signing the paperwork.
- Report your lost, stolen or misplaced membership card to us immediately.
You should also review periodically your claims history on the Member Centre section of the CBHS website. This is an option that demonstrates the benefits paid to you and directly to providers on your behalf when using your CBHS Membership card, admissions to hospital and medical treatment. (Please check the ‘Include provider remittances’ option to include payments to providers in the results).
- The named persons should be the ones who received the service or treatment.
- The number of services should be correct.
- The name of the provider should be the same as the provider who carried out the treatment or service.
- There should not be benefits paid for quotes or for services that were not provided.
- The number of days spent in hospital accommodation (whether shared or private) should be correctly specified. The admission and discharge dates should also be correct.
Inform us of fraud
If you suspect someone is making fraudulent claims or have any queries about inappropriate claiming, contact our fraud watch section immediately. You should also let us know if there are errors on your claim history report that can be reviewed on the CBHS website.
- Send an email to firstname.lastname@example.org – Attn: Member Care Manager
- Contact our Member Care team on 1300 654 123
Our no-tolerance policy for inappropriate claiming extends to members who knowingly attempt to defraud the Fund through submitting false claims or colluding with providers to submit false claims. For the benefit of other members in our family our Fund Rules allow us to terminate the membership of any member who behaves in this way.