Register of Generic Fraud Cases

Recently listed scams are highlighted in red in the table below.

FRAUD SCAM INFORMATION
Discipline	Fraud type	Brief Description	Detailed Description	Risk Rating	Source	Category	Recommended PHI Action
Chiro, Massage, Physio	Provider (Merrylands)	Provider first came to our attention after almost $32,000 of benefits were claimed through HICAPS on 31/12.	Onsite audit revealed little to no treatment notes. Benefits are claimed for all modalities on the same date of service. Provider has also up to 15 refer a friend payouts.	Medium – unsure if provider is targeting other funds	Identified from HICAPS report	HICAPS suspended, further investigations still active	Look for large benefit amounts being paid to same provider towards end of year.
Multiple	Member	Believed to be an international fraud ring targeting Australian insurance companies.	Up to 12 fraudulent policies were opened and claimed up to $35,000 worth of claims. Same IP linked to multiple policies.	Medium – may affect other funds	IP address reports	Memberships closed, reported to police	Undertake IP reports.
Dental	Provider	Provider claimed same crown/tooth multiple times		Medium	Identified by data analyst	Notes requested, recover overpayment	Check crown rules
Dental; Optical; Chiropractic	Member	Member claiming across multiple branches	Created invoices and claimed across multiple branches, receiving cash payouts.	Unknown if affecting other funds	Branch staff	Investigation underway	Check multiple-branch claims > $200