A wave of allegations against nearly 50 Australian doctors has sent ripples through the private healthcare system, prompting health insurers to urge patients to scrutinise their medical bills. The claims suggest that some specialists, including anaesthetists, surgeons, and other practitioners, have been systematically overcharging under “no gap fee” arrangements, raising questions about the trustworthiness of the system.
Patients have reportedly been hit with extra charges of up to $5000, despite assurances that no out-of-pocket expenses would apply. These fees, often labelled as “booking fees” or “administrative fees,” were allegedly charged while doctors claimed to Medicare they were “bulk billing” — a practice meant to leave patients without a fee.
Health insurers are now investigating these claims, with many cases appearing to involve anaesthetists and surgeons. Preliminary findings from a health fund survey indicate that 31% of patients in “no gap” arrangements were still billed, and nearly a quarter of those in “known gap” arrangements paid more than $500 — far exceeding the limits set by insurers.
Dr Rachel David, CEO of Private Healthcare Australia, has called for vigilance. “These allegations are deeply disturbing,” she said. “Patients, often at their most vulnerable, should not have to second-guess whether they’re being financially exploited. The power imbalance between doctors and patients makes this even more troubling.”
Dr David urged consumers to review their bills closely and to contact their health insurer or Medicare if discrepancies arise. “Your health fund can help you navigate this process,” she emphasised, advising Australians to act if their Medicare records show bulk billing but they were charged additional fees.
Private health insurance covers over 12.2 million Australians for hospital care and funds two-thirds of planned surgeries. Despite this, the financial burden of medical treatment is becoming a growing concern. The Australian Bureau of Statistics revealed that 11% of Australians avoided or delayed seeing specialist doctors due to cost, an increase from 8% the previous year.
Medicare data also paints a worrying picture. The bulk billing rate for specialist consultations dropped to 29% in 2023-24, down from 30% the previous year. Meanwhile, the Australian Prudential Regulation Authority reported that 83% of in-hospital services for insured patients were billed under “no gap” agreements, with another 9.3% under “known gap” arrangements. However, these figures are now under scrutiny due to allegations of hidden charges.
Dr David flagged a broader issue with transparency, describing the alleged “shadow billing” as an attack on public trust. “If doctors are charging under the table and failing to report that income, we can’t rely on Medicare statistics, APRA data, or the Medical Cost Finder to accurately reflect the real costs faced by patients,” she said.
With Medicare footing much of the healthcare bill through taxpayer funding, these allegations of fraud demand urgent investigation. Dr David stressed that taxpayers must not bear the cost of systemic misconduct in private healthcare. The stakes are high, not just for patients but for the integrity of Australia’s healthcare system.
How to report potential fraud to Medicare
You can report suspected fraud or corruption by: completing the Government’s health provider fraud tip-off form or calling the Government’s fraud hotline – 1800 829 403
or emailing ReportFraudorCorruption@health.gov.au.
How “no gap” fee arrangements work
Health insurers pay specialist doctors and private hospitals a higher fee than usual on the basis they will not charge the patient an out-of-pocket or “gap” fee.
How “known gap” fee arrangements work
Health insurers pay specialist doctors and private hospitals a higher fee than usual on the basis they will charge the patient a known out-of-pocket “gap” fee up to a maximum of $500.
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