Fraud Prevention

As a not-for-profit, Nurses & Midwives Health works hard to improve efficiencies, reduce operating costs and keep member premiums as low as financially sustainable. False claims adversely impact our operating expenses and every year we find that the number of fraudulent claims are increasing, despite our strict monitoring and auditing processes.

Private Healthcare Australia estimates that millions of dollars are lost every year in private healthcare through fraudulent or inappropriate claiming. This causes resources to be diverted away from the payment of necessary services and legitimate claims, which ultimately increases the premiums for people holding private health insurance.

Fraud can occur when a healthcare provider or health fund member provides misleading or false information or withholds information, such as:

• charging for treatment(s) that have not been provided
• creating false documents
• altering accounts to increase financial benefits.

What is Nurses & Midwives Health doing to detect and prevent fraud?

We have a dedicated investigation team that engages in a variety of activities designed to prevent losses or to detect and recover those losses on behalf of our members.

What can members do?

To ensure that your membership is protected from fraud or misuse and help us keep premiums as low as possible, you can:

• report any stolen or lost membership cards within 24 hours
• never leave your membership card with service providers
• check your limits online
• keep your online member services password safe and change it regularly
• always check your receipts including signing for services claimed electronically.

Nurses & Midwives Health and the investigations team will always treat any concerns that you raise with the utmost confidentiality and protect your identity or respect your right to remain anonymous.

Please report any suspicious activity to Nurses & Midwives Health on 1300 344 000 or email investigations@nmhealth.com.au