Bupa HI Pty Ltd has been ordered by the Federal Court to pay $35 million in penalties following findings of unconscionable conduct and making false or misleading representations about members’ health insurance entitlements. The conduct, which spanned from May 2018 to August 2023, involved misleading or deceptive practices and false representations regarding members’ entitlements to private health insurance benefits.
The Australian Competition and Consumer Commission (ACCC) initiated proceedings against Bupa on 30 June 2025. The Federal Court’s decision highlights Bupa’s engagement in unconscionable conduct between June 2020 and February 2021, specifically related to the incorrect assessment of Mixed Coverage Claims. The majority of affected claims involved hospital treatments with multiple procedures, where Bupa incorrectly rejected entire claims when only part of the treatment was covered by the policy.
Bupa, the second largest private health insurance company in Australia with a 25.5% market share and approximately 4.5 million members, cooperated with the ACCC during the investigation. The company agreed to joint submissions regarding liability and penalties. In addition to the financial penalty, the Federal Court has ordered an injunction preventing Bupa from engaging in similar conduct for five years.
The ACCC Deputy Chair, Catriona Lowe, commented on the impact of Bupa’s conduct, stating, “Bupa’s conduct impacted thousands of consumers. During our investigation we heard from Bupa members who suffered significant harm, including financial harm as well as pain, suffering and emotional distress as a result of Bupa’s conduct.” Lowe further noted, “Some of Bupa’s members decided to cancel, delay or forego necessary treatment, resulting in potential medical risks or complications, because they were incorrectly told they were not entitled to health insurance benefits.”
Lowe emphasised the importance of accurate coverage, saying, “Private health insurance can be a significant expense for consumers and people rightly expect to receive the level of coverage they pay for.” She described Bupa’s actions as “extremely serious conduct,” noting, “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.”
To address the issue, Bupa has commenced a remediation program, having paid over $14.3 million to date for more than 4100 affected claims. The ACCC’s action against Bupa underscores the obligations of health insurers under Australian Consumer Law. Lowe stated, “Today’s outcome should serve as a reminder to all health insurers of their obligations under the Australian Consumer Law, including that they must ensure that claims are assessed correctly so that their members receive the benefits they are entitled to under their policies.”
