The Australian Department of Health and Aged Care ('the Department') develops and delivers policies and programs to ensure better health for all Australians throughout their lives, and advises the Government on health and aged care matters.
What types of complaints can you make?
You can complain to the Department for the following:
- Suspected Fraud: If you suspect fraudulent activity involving a health service, health provider or Department staff.
- Incorrect or Improper Medicare or Pharmaceutical Benefits Claims: Medical practitioners whose claims are not accurate and appropriate under the Medicare Benefits Schedule (MBS) or medical prescriptions under the Pharmaceutical Benefits Scheme (PBS).
- Corrupt Conduct by Department Staff: If you believe a member of the Department’s staff has engaged in corruption, which might include bribery, conflicts of interest, manipulation, seeking gifts and more, or improper disclosures.
- Aged Care Assessment Team (ACAT) Decisions: If you or one of your loved ones has undergone an ACAT assessment and disagree with the decision about what aged care services or supports you are eligible for, you can complain to the Secretary of the Department and request a review of the decision.
Jurisdiction:
The Department investigates complaints about Australian health providers, regardless of where the incident occurs.
Time Limitations:
There are no time limitations on the complaints that the Australian Department of Health and Aged Care can investigate.
The Department will not deal with complaints about:
- Fraudulent Activity Complaints: Unethical or unsafe behaviour by health professionals. Examples include:
- Poor treatment, such as wrong or inadequate diagnosis or treatment.
- Not providing enough information, such as about a diagnosis or treatment.
- Inappropriate behaviour or relationships, such as a sexual relationship between a doctor and a patient.
- A doctor working under the influence of drugs or alcohol.
- Complaints about Fees Charged by Health Providers: The Department does not handle complaints about the fees charged, other than allegations of fraudulent MBS (Medicare Benefits Schedule) or PBS (Pharmaceutical Benefits Scheme) claims. The price of private health services in Australia is not regulated.
- ACAT Assessment Complaints: The Department can only handle complaints about the outcome or decision following an Aged Care Assessment Team (ACAT) assessment. It does not handle complaints about the assessment process, such as the time taken or the customer service provided by the assessor.
Who can you make a complaint against?
You can make a complaint against:
- Health providers: Complaints about suspected fraud, incorrect billing or inappropriate MBS or PBS claims can be made about any health provider including:
- Service providers and their employees
- Health professionals and their employees
- Services and programs that are funded by the Department: You can make a complaint about a service or program that is funded by the Department engaging in fraudulent activity of being the victim of fraud.
- Staff of the Department
- Aged Care Assessment Team (ACAT): You can make a seek a review of a decision by the Aged Care Assessment Team (ACAT).
You cannot make a complaint about:
The Department does not investigate fraud by the general public, only health providers.
Are you eligible to make a complaint?
Who can make a complaint?
Anyone can make a complaint. There are no exceptions on who can make a complaint
Before you lodge a complaint:
There are no steps that need to be made prior to making a complaint
Making a Complaint on Someone’s Behalf?
Yes, you can make a complaint on behalf of someone else.
Additional information:
All information received is treated securely, sensitively and confidentially.
What can this body do to help?
Fraudulent activity complaints
The departments complaint handling work is focused on identifying and addressing fraudulent or corrupt activity. This can result in any of the below consequences for the respondent.
- Referral to the Australian Federal Police or National Anti-Corruption Commission: Evidence of serious or complex criminal conduct may be referred to the Australian Federal Police. Corruption issues may be referred to the National Anti-Corruption Commission.
- Referral for Prosecution: Where sufficient evidence of criminal conduct is identified, investigators will compile and refer briefs of evidence to the Commonwealth Director of Public Prosecutions to consider prosecution action.
- Recovery: All reasonable measures to recover any losses caused by fraudulent or corrupt conduct, including formal proceeds of crime action, civil recovery processes and administrative recovery.
- Post-Incident Reviews: Reviews of investigations, or incidents related to fraud or corruption, are undertaken with the relevant departmental programs.
- Non-Compliance: When a complaint shows that a health or aged care service hasn't followed the rules, the Department of Health and Aged Care steps in, and the service must make changes to meet the required standards to ensure everyone receives safe and proper care.
ACAT Decision Complaints
ACAT Reconsideration: If you have requested a review of an ACAT assessment the Secretary may decide to wholly or partial change the decision.
How to prepare your complaint
Format:
Complaints about suspected fraud, incorrect billing, or inappropriate MBS or PBS claims can be lodged in writing or verbally. Complaints about ACAT decisions need to be lodged in writing.
Personal Details:
You can choose to lodge your complaint anonymously. However, if you do not provide your name and contact details, the investigating team will not be able to contact you if more information is required, which may impact their ability to act on your concerns. If you are comfortable providing your personal information, this should include your:
- First and last name
- Contact number
- Email and postal address
If you are requesting a review of an ACAT decision that you disagree with, you need to provide your name and contact information.
Respondent’s Details:
You should provide the name of the health service or health practitioner you believe has done the wrong thing.
Fraudulent Activity Complaints:
For complaints about fraudulent activity, you should provide as much information as possible to help the Department understand your concerns. This should include:
- What has happened that you think is wrong?
- Where did it happen?
- When did it happen?
- How did you become aware of the problem?
- Any relevant reference numbers, such as the Provider Number, Prescriber Number, ABN, or Pharmacy Approval Number.
If you have any evidence or supporting documentation, you should also provide that.
ACAT Assessment Complaints:
Your letter should clearly explain why you believe the decision is wrong and should be changed.
What NOT to Include:
Do not make false or misleading statements. This may be an offence.
Lodging your complaint and next steps:
Where to lodge your complaint:
- Fraudulent activity complaints
- Online: Online Form
- Email: fraudsection@health.gov.au
- Post: Department of Health and Aged Care, GPO Box 9848, Canberra ACT 2601, Australia
- ACAT assessment complaints
- Post: The Secretary
Department of Health and Aged Care
Attn: Aged Care Assessment Program Reconsiderations
GPO Box 9848
Adelaide SA 5001
- Post: The Secretary
Next Steps:
- Acknowledgement: Your complaint will be officially acknowledged, typically within 5 working days. This means you'll receive confirmation that your complaint has been received and is being processed.
- Assessment: Trained staff will assess your complaint to understand its nature and severity. This step involves deciding how the complaint should be handled and what actions are needed.
- Investigation: If necessary, a more detailed investigation will be conducted. This involves gathering and analysing all relevant information, documents, and possibly conducting interviews to understand the facts fully.
- Fraudulent Activity Complaints: If your complaint is not within the Department's jurisdiction, where appropriate, your complaint may be referred to another relevant body.
- Investigation: All in-jurisdiction complaints will be carefully considered by the Department. If the information you have provided warrants an investigation, it will be conducted by the Department in accordance with the Australian Government Investigation Standards. This includes serious or complex criminal investigations, which may be referred to the Australian Federal Police, or corruption issues which may be referred to the National Anti-Corruption Commission. Matters outside the Department's responsibility are referred to the relevant entity. All disclosures involving another agency’s activities or programs will accord with the Privacy Act 1988 and the Australian Privacy Principles.
More information:
Refer to the factsheet provided below for more information.
