Health insurer Bupa has been directed by the Australian Federal Court to pay a A$35m ($23.2) penalty after the company was found to have engaged in “misleading” conduct concerning health insurance claims.  

The ruling relates to statements made by Bupa between May 2018 and August 2023 regarding members’ entitlements and includes an order restricting similar practices for five years. 

Bupa provided information to members stating they were not eligible for any benefits on certain claims, even though these members were entitled to receive benefits for treatments included in their policy coverage. 

The Court also found that, from June 2020 to February 2021, Bupa engaged in “unconscionable conduct” with its assessment of Mixed Coverage Claims.  

This occurred most frequently with hospital procedures involving more than one treatment, where partial coverage existed but entire claims were rejected instead of partially paid. 

In these situations, some elements of treatment were covered while others were not, but Bupa denied all payment. 

This conduct affected not only members but also hospitals and medical providers, which did not receive payments owed under certain claims.  

During the Australian Competition and Consumer Commission (ACCC) inquiry, Bupa worked with the regulator and agreed to joint recommendations on orders covering liability and penalties. 

ACCC deputy chair Catriona Lowe said: “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.  

“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.” 

In June 2025, Bupa gave the ACCC a court-enforceable undertaking to deliver compensation through a remediation programme, covering benefits due plus interest for affected members, hospitals and healthcare providers. 

So far, more than A$14.3m has been distributed for over 4,100 resolved claims as part of this process.  

In a statement, Bupa said: “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 and have taken actions to ensure this doesn’t occur again.” 

In June this year, Bupa was fined A$35m after admitting its conduct led more than 4,000 individuals to miss out on hospital benefits they should have received.