Bupa has been hit with a substantial $35 million fine after it was discovered the company misled individuals, hospitals, and medical providers regarding its private health insurance benefits. The judgment was passed down by the federal court, which found Bupa guilty of engaging in false, misleading, deceptive, and unconscionable conduct.

The case centered on allegations that, between May 2018 and August 2023, Bupa incorrectly informed members they were not eligible for benefits related to mixed coverage and uncategorised item claims. In reality, these members were entitled to such benefits.

As a result of this misconduct, over 4,100 claims were adversely affected. These claims primarily involved hospital treatments where multiple procedures were conducted simultaneously. Additionally, some instances involved claims where only a portion of the treatment was covered under the policyholder’s plan.

These claims were mostly for hospital treatments where two or more procedures were performed at the same time.

Some were for claims where only part of the treatment was covered by a member’s policy.

Medical providers and hospitals also did not receive the money they were entitled to.

The Australian Competition and Consumer Commission (ACCC) began court action against the nation’s second-largest private health insurer in June.

Today, the federal court has ordered Bupa to pay $35 million and abide by a five-year injuction prohibting the provider from breaching the rules.

Bupa has paid back most of the affected customers $14.3 million relating to more than 4100 claims. 

ACCC Deputy Chair Catriona Lowe said Bupa’s actions were “extremely serious” as thousands of customers suffered financial harm, pain, suffering and emotional distress.

“Some of Bupa’s members decided to cancel, delay or forego necessary treatment, resulting in potential medical risks or complications, because they were incorrectly told they were not entitled to health insurance benefits,” she said.

“Private health insurance can be a significant expense for consumers, and people rightly expect to receive the level of coverage they pay for.”

Bupa accepted the court decision and apologised to its customers.

“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,” the provider said in a statement.