Bupa HI Pty Ltd (Bupa) has been ordered to pay a $35 million penalty by the Federal Court for engaging in unconscionable conduct and making false or misleading representations concerning private health insurance benefits. The penalty stems from Bupa’s incorrect assessment of claims and advice provided to thousands of members, hospitals, and medical providers between May 2018 and August 2023.

The Federal Court declared that Bupa engaged in misleading or deceptive conduct by incorrectly advising members they were not entitled to benefits for any part of their claim, despite the fact that these members were entitled to coverage for certain treatment under their policy. Furthermore, the Court declared that Bupa engaged in unconscionable conduct between June 2020 and February 2021 in connection with its incorrect assessment of specific claims.

Incorrect Rejection of Mixed Coverage Claims

The core issue involved “Mixed Coverage Claims,” primarily for hospital treatment where two or more procedures were performed at the same time. In scenarios where part of the treatment was covered by a member’s policy but part was not, Bupa incorrectly rejected the entire claim.

ACCC Deputy Chair Catriona Lowe stated that Bupa’s conduct impacted thousands of consumers who suffered significant harm, including financial loss, pain, suffering, and emotional distress. Due to being incorrectly told they were ineligible for benefits, some Bupa members chose to cancel, delay or forego necessary treatment, potentially leading to medical risks or complications. Hospitals and medical providers were also impacted by not receiving entitled payments for certain members’ claims.

“We consider this to be extremely serious conduct, and this is reflected in Bupa’s admission that it engaged in unconscionable conduct, which is one of the most serious types of misconduct under the consumer laws that we enforce,” Ms Lowe said.

Court Orders and Remediation Program

In addition to the $35 million penalty approved by the Federal Court, the Court also imposed an injunction restraining Bupa from engaging in the contravening conduct for a period of five years.

Bupa acknowledged the Federal Court’s orders in response to breaches of the Australian Consumer Law. The health insurer cooperated with the ACCC during the investigation and agreed to make joint submissions to the Court regarding liability and penalties.

“We remain deeply sorry for these errors and have apologised to our affected customers for the impact this has had on them and their families,” Bupa stated, confirming that they have accepted the Federal Court’s decision.

Bupa commenced a remediation program prior to the court action and provided the ACCC with a court enforceable undertaking in June this year to complete the process. This program compensates affected members, hospitals, and medical providers, covering the amount members were entitled to but did not receive, plus interest. To date, Bupa has already paid back a total of $14.3 million covering more than 4,100 affected claims, as of November 5, 2025.

The ACCC emphasized that the outcome should serve as a strong reminder to all health insurers regarding their obligations to correctly assess claims and ensure members receive their entitled benefits.