Health insurers accused of ‘illegally rejecting’ claims

A GOVERNMENT whistleblower is alleging some of Australia's biggest private health companies failed to follow protocol when they rejected 'thousands' of claims.

The Guardian is reporting the allegations of an anonymous government whistleblower, who says the incidents happened over the past seven years.

"I am going public with this story because it doesn't seem right that the authorities say nothing to the public after finding health insurers breaking the law," the whistleblower said, according to

"I believe this was plainly illegal corporate wrongdoing and the authorities should have taken it seriously."

The documents reportedly show that the health insurance companies failed to follow protocol and have doctors review cases, which they deemed the basis of "pre-existing medical conditions".

This included insurance giant NIB Health Funds, which admitted to the ombudsman that its practices were not "aligned to the legislative requirements", The Guardian reported.

Bupa also previously admitted to rejecting more than 7700 claims without having doctors review them.

NIB was mentioned in the leaked documents. Picture: Supplied
NIB was mentioned in the leaked documents. Picture: Supplied

Another fund, HCF, was questioned over failing to have doctors review the rejected cases twice - in June 2016 and March 2018, the leaked documents alleged.

"I believe that based on the alarming developments with Bupa and NIB, plus the suspicious refusal of HCF to provide evidence, the ombudsman had reasonable grounds to carry out what is called an 'own-motion' investigation to determine the extent of the problem," the whistleblower told The Guardian.

The news comes after a recent News Corp investigation of health funds including Medibank, NIB, HCF and BUPA have found some to be gouging their members.

The investigation has found Australia's second largest health insurer Medibank has not increased rebates it pays to its 2.8 million members for hospital procedures for five years.

NIB has increased its rebates for common procedures by less than one per cent (0.007 per cent) in the last three years.

BUPA has not increased the rebates it pays for childbirth for at least three years while rebates for other common procedures have increased by just over one per cent, substantially less than the inflation rate.

HCF has not increased it rebates for many common procedures since March 2018.