The British health insurance provider Bupa has agreed to a $35 million fine in Australia after acknowledging “ruthless conduct” related to rejecting valid claims from patients over a five-year span.
The Australian Consumer Commission (ACCC) initiated legal action against Bupa, alleging that the UK-based company was involved in “misleading” practices from May 2018 to August 2023.
While a penalty has been imposed, it can still be altered by the court.
This move is part of a broader enforcement trend by Australian regulators targeting various companies, including supermarkets and banks, particularly in light of controversies surrounding Qantas and HSBC, as well as concerns over governance and consumer protection.
The case against Bupa centers on “mixed compensation” claims—instances where a patient sought coverage for multiple procedures during a hospital visit but had one procedure deemed ineligible under their policy. The ACCC claims that Bupa outright rejected these claims, even when parts were legitimate.
Gina Cass-Gottlieb, chair of the ACCC, highlighted that these rejections led many customers to pay out of pocket, upgrade their insurance policies, or, in some unfortunate cases, even discontinue necessary treatments due to soaring costs.
“Bupa’s practices have impacted thousands of members over the past five years, resulting in harm for consumers who faced delays, cancellations, or treatment denials by their health insurance,” Cass-Gottlieb stated.
Nick Stone, overseeing Bupa’s operations in the Asia Pacific, admitted to the “ruthless conduct” and noted that the company has compensated customers $14.3 million so far, covering around 4,100 claims and eligibility assessments. “This should never have occurred,” he remarked.
Bupa Asia Pacific, covering operations in Australia, New Zealand, and Hong Kong, represented the largest segment of the company last year, accounting for 37% of its £16.9 billion revenue and nearly £914 million in underlying profits.
Bupa entered the Australian market in 2002, merging with local rivals and becoming the second-largest private insurance provider in the country after Medibank Private, serving about 4.5 million customers.
The Australian government is working to subsidize private health insurance as a way to ease the burden on the public health system and boost adoption rates.
Bupa is also looking to expand into Australia’s aged care and healthcare sectors, and is connected to recent bids involving HealthScope, a hospital operator that recently went into management.
However, Bupa has declined to specify whether it aims to acquire the company.
