Latest news with #GinaCassGottlieb
Yahoo
30-06-2025
- Business
- Yahoo
Health insurer fined $35m, misled 4k members
Private health insurer Bupa has been fined $35m after conceding it engaged in misleading or deceptive conduct to talk more than 4000 Australians out of claiming hospital treatments. The Australian Competition and Consumer Commission said in a statement on Monday that Bupa admitted to the breaches after telling customers they were not entitled to private health insurance benefits for their claims, even though they were entitled to make a claim. This left some customers thousands of dollars out of pocket for medical treatments they had to pay for when Bupa should have paid at least part of the bill. The ACCC said some policyholders also upgraded to more expensive policies to ensure they were covered. ACCC chair Gina Cass-Gottlieb said Bupa's conduct affected thousands of members over more than five years and caused harm to consumers, some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies. 'Consumers purchase private health insurance to provide peace of mind, certainty of coverage and the ability to choose where and when to undertake their procedures,' Ms Cass-Gottlieb said. 'Bupa's conduct denied certain members benefits to which they were entitled to under their private health insurance policies.' Bupa APAC chief executive Nick Stone said he was deeply sorry for failing to get things right because customers were saddened by the impacts this has had on them or their families. 'Our priority has been to communicate and compensate our affected health insurance customers and providers, along with putting in place measures to help ensure this does not happen again,' Mr Stone said. Bupa has admitted over a five-year period between May 2018 and August 2023 that it misrepresented members over two separate insurance types – 'mixed cover claims' and 'uncategorised items'. A mixed cover claim includes both treatment that is covered in part by a customer's policy and another part covered by the customer itself. According to Bupa, the private health insurer pays out more than $20m in claims a year as well as six million in-hospital and medical claims, with the mixed coverage claims representing less than 0.02 per cent of assessed customers over the five-year period. Similarly, Bupa says about 0.004 per cent of claims fall under uncategorised items, which include treatments that were not assigned to a standard clinical category in Bupa's claims assessment systems. The ACCC says Bupa's conduct occurred because Bupa staff did not have consistent and clear instructions and training for assessing mixed coverage claims, and its systems were programmed to incorrectly reject mixed coverage and uncategorised item claims. 'Private health insurance is complex, and consumers should be able to trust their health insurer to assess and pay health insurance claims accurately,' Ms Cass-Gottlieb said. 'Bupa's conduct is very serious and falls well short of what is expected of one of the largest health insurers in Australia. Bupa should have invested in the necessary systems, processes and training to prevent this from happening, and address it promptly when it occurred.' The ACCC and Bupa will jointly ask the court to order Bupa to pay a penalty of $35m among other orders. It is a matter for the court to determine whether the penalty and other orders are appropriate. Bupa started compensating affected members, medical providers and hospitals before the start of this legal action and has paid $14.3m for more than 4100 affected claims. Sign in to access your portfolio
News.com.au
30-06-2025
- Business
- News.com.au
Bupa fined $35m for ‘misleading or deceptive conduct' impacting 4k Aussies
Private health insurer Bupa has been fined $35m after conceding it engaged in misleading or deceptive conduct to talk more than 4000 Australians out of claiming hospital treatments. The Australian Competition and Consumer Commission said in a statement on Monday that Bupa admitted to the breaches after telling customers they were not entitled to private health insurance benefits for their claims, even though they were entitled to make a claim. This left some customers thousands of dollars out of pocket for medical treatments they had to pay for when Bupa should have paid at least part of the bill. The ACCC said some policyholders also upgraded to more expensive policies to ensure they were covered. ACCC chair Gina Cass-Gottlieb said Bupa's conduct affected thousands of members over more than five years and caused harm to consumers, some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies. 'Consumers purchase private health insurance to provide peace of mind, certainty of coverage and the ability to choose where and when to undertake their procedures,' Ms Cass-Gottlieb said. 'Bupa's conduct denied certain members benefits to which they were entitled to under their private health insurance policies.' Bupa APAC chief executive Nick Stone said he was deeply sorry for failing to get things right because customers were saddened by the impacts this has had on them or their families. 'Our priority has been to communicate and compensate our affected health insurance customers and providers, along with putting in place measures to help ensure this does not happen again,' Mr Stone said. Bupa has admitted over a five-year period between May 2018 and August 2023 that it misrepresented members over two separate insurance types – 'mixed cover claims' and 'uncategorised items'. A mixed cover claim includes both treatment that is covered in part by a customer's policy and another part covered by the customer itself. According to Bupa, the private health insurer pays out more than $20m in claims a year as well as six million in-hospital and medical claims, with the mixed coverage claims representing less than 0.02 per cent of assessed customers over the five-year period. Similarly, Bupa says about 0.004 per cent of claims fall under uncategorised items, which include treatments that were not assigned to a standard clinical category in Bupa's claims assessment systems. The ACCC says Bupa's conduct occurred because Bupa staff did not have consistent and clear instructions and training for assessing mixed coverage claims, and its systems were programmed to incorrectly reject mixed coverage and uncategorised item claims. 'Private health insurance is complex, and consumers should be able to trust their health insurer to assess and pay health insurance claims accurately,' Ms Cass-Gottlieb said. 'Bupa's conduct is very serious and falls well short of what is expected of one of the largest health insurers in Australia. Bupa should have invested in the necessary systems, processes and training to prevent this from happening, and address it promptly when it occurred.' The ACCC and Bupa will jointly ask the court to order Bupa to pay a penalty of $35m among other orders. It is a matter for the court to determine whether the penalty and other orders are appropriate. Bupa started compensating affected members, medical providers and hospitals before the start of this legal action and has paid $14.3m for more than 4100 affected claims.
ABC News
30-06-2025
- Business
- ABC News
Private Health insurer Bupa agrees to repay $35 million over incorrectly rejected claims
One of Australia's largest private health insurers has agreed to pay back tens of millions of dollars to thousands of members who had hospital claims incorrectly rejected. Bupa has admitted to engaging in misleading or deceptive conduct and making false or misleading representations by advising members they were not entitled to private health insurance benefits when they were. Bupa reached an agreement with the ACCC on a proposed penalty of $35 million for incorrectly assessing thousands of mixed coverage and uncategorised item claims and related eligibility checks over a five-year period. The company also admitted to engaging in unconscionable conduct relating to its assessment of 388 mixed coverage claims, which included treatment that was covered under a member's private health insurance policy as well as treatment that was not covered under their policy. In a statement, Bupa APAC CEO Nick Stone said the issue should "never have happened" and the company was "deeply sorry for failing to get things right for our customers". Bupa, is Australia's second largest private health insurer and has more than four million members. It has already started compensating affected members, medical providers and hospitals and has so far paid $14.3 million with more than 4,100 affected claims. ACCC Chair Gina Cass-Gottlieb said the consumer watchdog had accepted Bupa's undertaking to continue compensating affected parties. "Bupa's conduct ... caused harm to consumers some of whom delayed, cancelled or went without treatment for which they were, at least partially, covered under their health insurance policies," Ms Cass-Gottlieb said. Bupa said the errors occurred as a result of inaccurate or unclear instructions, training or guidance which meant Bupa didn't always make correct assessments of claims and eligibility checks or act quickly enough to fix issues. Any customers who believe they may have had a historical claim or eligibility check incorrectly assessed can can visit or call Bupa on 134 135. Australian private health insurance industry's peak representative body, Private Healthcare Australia has been contacted for comment.
ABC News
26-06-2025
- Business
- ABC News
AGN accused of running dodgy 'Love Gas' ads that deceived audiences
One of Australia's biggest gas companies has misled "millions" of people by claiming its energy distribution network is becoming renewable, Australia's consumer watchdog alleges in its biggest "greenwashing" case yet. The ACCC (Australian Competition and Consumer Commission) action in the Federal Court relates to a series of "Love Gas" advertisements that Australian Gas Networks (AGN) ran back in 2022 and 2023. "The ads claimed that the gas that Australian Gas Networks supplies and distributes to households would be renewable within a generation," ACCC chair Gina Cass-Gottlieb told ABC News. "We allege, in fact, it didn't have a sufficient basis for making these claims." AGN owns gas transmission pipelines and other infrastructure that deliver the energy source to around 1.3 million homes and businesses around Australia. In recent years, the company has been pushing alternatives to fossil-fuel derived gas, including hydrogen made from renewable energy and biomethane derived from the processing of waste products. But these energy sources are in their infancy, and the ACCC action argues the science isn't there for AGN to make the claims that its network is going renewable. "There are a range of significant technical and economic obstacles," Ms Cass-Gottlieb said. "We are concerned that consumers were deprived of the opportunity to make informed choices about the right energy source for use in their homes. "For the household appliances that they're buying for the future and also for the steps that each of us can take in our lives to enhance sustainability." AGN will defend the action, a spokesperson for the company's parent company, AGIG (Australian Gas Infrastructure Group), said. "We always strive to provide clear and accurate communications about the role and benefits of natural gas today and renewable gas into the future," they said. "For this reason, we are disappointed with the ACCC's decision to take proceedings and will be defending these claims. "AGIG will not be making any further comment at this stage." The ACCC took action against AGN after the Australian Conservation Foundation (ACF) and members of the public raised concerns. The ACF's chief executive, Kelly O'Shanassy, welcomed the ACCC action on Thursday. "Gas is a polluting fossil fuel that, when dug up and burnt, releases billions of tonnes of emissions, driving global warming and dangerous climate-fuelled events like floods, fires and droughts," Ms O'Shanassy said. "The gas industry knows fossil fuels are not renewable, but it continues to try and hoodwink Australians into thinking gas is good for us. The matter will be heard in the Federal Court, where the ACCC will be seeking declarations, penalties, costs, and other orders against AGN. AGIG aims to reduce its emissions by 30 per cent by the end of the decade for its Scope 1 and 2 emissions. These cover the operations of its facilities and pipelines — including any gas that is leaked into the air in the process — but not the burning of the gas at its destination. AGN has also disputed a recent finding by the Ad Standards board about its controversial advertising for the Masterchef campaign. "While we disagree with the panel's decision that one aspect of our advertisement could be considered vague, we have made the decision to remove it from publication while we consider next steps," the spokesperson said. The company faces fines of up to $50 million per contravention.
The Guardian
26-06-2025
- Business
- The Guardian
Australian consumer watchdog takes gas company to court alleging it misled consumers over renewables claim
Australia's competition watchdog has launched federal court action against Australian Gas Networks, alleging the company misled consumers with its 'Love Gas' campaign. The advertisements, which ran on free-to-air television, streaming and YouTube during 2022 and 2023, claimed household gas would be 'renewable' within a generation. Sign up for Guardian Australia's breaking news email But Australian Gas Networks did not have reasonable grounds for making that claim, according to the Australian Competition and Consumer Commission (ACCC), given the significant technical and economic barriers to distributing renewable gas to households. 'We allege that Australian Gas Networks engaged in greenwashing in its 'Love Gas' ad campaign,' the ACCC chair, Gina Cass-Gottlieb, said. 'We say these ads were intended to encourage consumers to connect to, or remain connected to, Australian Gas Networks' distribution network and to purchase gas appliances for their homes, based on the misleading impression they would receive 'renewable gas' within a generation.' The advertisements featured a young girl and her father using gas appliances in the home, with voiceovers that included 'it's becoming renewable'. Each ended with the company's logo next to a green flame, along with the words: 'Love gas. Love a renewable gas future' – with no qualifications, fine print or disclaimers. 'Renewable gas' usually refers to a mix of hydrogen and fossil gas. A spokesperson for Australian Gas Networks said they were disappointed with the ACCC's decision to start proceedings and they would defend the claims. 'We always strive to provide clear and accurate communications about the role and benefits of natural gas today and renewable gas into the future,' the spokesperson said. The ACCC said it began the investigation after complaints from consumers and the Australian Conservation Foundation (ACF). The ACF chief executive, Kelly O'Shanassy, welcomed the ACCC's court action. 'Gas is a polluting fossil fuel that when dug up and burned releases billions of tonnes of emissions, driving global warming and dangerous climate-fuelled events like floods, fires and droughts,' she said. Sign up to Breaking News Australia Get the most important news as it breaks after newsletter promotion 'The gas industry knows fossil fuels are not renewable but it continues to try and hoodwink Australians into thinking gas is good for us.' ACF's original complaint, made in 2022, said the ads were misleading because not all forms of hydrogen were renewable, and most products being developed were blended with fossil gas. The climate organisation Comms Declare has also filed several complaints about the company's use of the term 'renewable gas'. 'We hope the misleading term 'renewable gas' can now be buried once and for all,' founder Belinda Noble said. 'You can't re-use something that has been burned, and you shouldn't promise to deliver a product that is not viable.' Cass-Gottlieb said businesses making environmental claims about the future must have reasonable grounds, or would be taken to be misleading under the Australian consumer law. 'Businesses must take care when they promote emissions-reduction measures that their claims can be backed up with evidence, and that they are realistic about emerging energy technologies and when changes are likely to be achieved.'
