The Federal Court has formally ordered Bupa to pay A$35m (US$23.26m) in penalties, bringing closure to enforcement action launched in June over misrepresentations and claim assessment failures affecting thousands of policyholders.
The ruling follows Bupa’s agreement earlier this year to the proposed penalty after admitting it made false or misleading representations and engaged in unconscionable conduct when assessing mixed coverage claims and uncategorised item claims between May 2018 and August 2023.
The Court found that Bupa incorrectly advised some members that they were not entitled to any benefit, despite their policies providing cover for part of the treatment received.
The ACCC said most affected claims involved hospital procedures performed concurrently, where Bupa erroneously rejected entire claims if at least one component fell outside the member’s cover. In its June filing, the regulator alleged that Bupa’s systems were programmed to incorrectly reject these claim types and that staff had not been given adequate training to identify and correct these errors.
In Friday’s judgment, the Court also declared that Bupa’s handling of some mixed coverage claims between June 2020 and February 2021 amounted to unconscionable conduct. It imposed a five-year injunction restraining the insurer from repeating the contravening behaviour.
ACCC deputy chair Catriona Lowe reiterated the scale of the impact, saying “Bupa’s conduct impacted thousands of consumers,” and noted that some members delayed or cancelled treatment after being incorrectly told they were not entitled to benefits.
The Federal Court’s decision aligns with Bupa’s earlier admissions and the joint submissions made with the ACCC on liability and penalties. As previously disclosed, Bupa commenced remediation before proceedings began and has paid more than A$14.3m across more than 4,100 affected claims. The insurer has also provided a court-enforceable undertaking requiring it to complete its remediation programme for members, hospitals, and medical providers.
Bupa, which processes around 20 million claims annually, has said that the issues represented a small proportion of total assessments but acknowledged shortcomings in systems, training, and manual review processes.
