ACCC sues Bupa for unconscionable conduct, misleading consumers
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The news: The Australian Competition and Consumer Commission (ACCC) has started proceedings in the Federal Court against healthcare giant Bupa for unconscionable conduct and misleading thousands of consumers about health insurance benefits entitlements.
The numbers: The ACCC and Bupa will jointly ask the court to order Bupa to pay a total penalty of $35 million, among other orders.
The context: Bupa has admitted to engaging in misleading or deceptive conduct and making false or misleading representations by incorrectly advising members they were not entitled to private health insurance benefits for their entire claim.
Bupa has also admitted to engaging in unconscionable conduct in connection with its assessment of 388 Mixed Coverage Claims.
Most of these claims 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.
The ACCC said some consumers were left thousands of dollars out of pocket and had to personally finance expenses for some medical treatments that Bupa was obliged to pay under its policies. Some policy holders also upgraded to more expensive policies to ensure coverage.
The regulator also claimed some consumers were exposed to potential medical risks or complications, physical pain and distress as a result of not proceeding with medical treatment.
Medical providers and hospitals were also impacted by the conduct, including by not receiving the payments to which they were entitled in respect of certain claims.
Bupa started compensating affected members, medical providers and hospitals before the start of this legal action and, to date, has paid $14.3 million to parties for more than 4100 affected claims.
The ACCC has accepted a court-enforceable undertaking from Bupa to continue compensating affected parties under its existing remediation program.
What they said: “Bupa’s conduct affected thousands of members over more than five years, and caused harm to consumers some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies,” said ACCC chair Gina Cass-Gottlieb.
The source: ACCC media release
