Fraud and vigilance 

We take fraud very seriously. Please contact us if you notice any suspicious activity on your membership. 


Preventing fraud 

Fraud impacts us all. Every case of fraudulent claiming contributes to costs, which can then lead to higher premiums. We have a zero-tolerance policy for inappropriate claiming. Insurance fraud is a serious criminal offence. Our investigations team identifies fraud and prosecutes offenders.  

 

Examples of fraud 

Insurance fraud can originate in a provider’s office, from the people covered by a membership or from the health fund.

Examples of insurance fraud include: 

  • Inaccurate recording or claiming of treatments and services. 
  • An agreement between a member and a provider to claim fraudulently. 
  • Claiming for services or treatments that were not provided. 
  • Altered receipts or falsifying documents. 
  • Allowing a non-member to use your CBHS Corporate Health membership card. 

 

How to reduce the risk of fraud

There are steps that you can take to reduce the risk of fraud and inappropriate claims. 

  • Keep your CBHS Corporate Health 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. 
  • The people named 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 any benefits paid for quotes or for services that were not provided. 

You should also periodically review your claims history in the Member Centre on our website. This shows benefits paid to you, and to providers on your behalf, using your membership card. (Please check the ‘Include provider remittances’ option to include payments to providers). This section also shows admissions to hospital and medical treatment. Contact us immediately if you notice any errors. 


Member fraud 

Our zero-tolerance policy for inappropriate claiming extends to members who knowingly attempt to defraud the fund by submitting false claims or colluding with providers to submit false claims.  

For the benefit of other members, our fund rules allow us to terminate the membership of any member who behaves in this way. 


Inform us of fraud 

If you suspect someone is making fraudulent claims or if you have any queries about inappropriate claiming, contact us immediately. You should also let us know if there are errors on your claim history report on our website. 

  • Send an email to investigations@cbhscorp.com.au – for the attention of Head of Claims 
  • Contact our Member Care team on 1300 586 462