Health insurers access full medical records in 'aggressive' audits

Health insurers are seeking comprehensive medical records in intrusive audits, raising concerns over privacy violations. Private insurers are demanding access to patients' full clinical histories, which some providers view as aggressive audit practices. The Australian Private Hospitals Association has labeled these audits as aggressive.

Insurers typically have permission to collect wide-ranging data on customers through contracts and privacy policies, encompassing data from security camera footage to personal social media posts. While insurers are entitled to request medical practitioners' notes for billing accuracy, hospitals and allied health providers warn of insurers requesting full clinical histories.

Bupa, a prominent health insurer, has been accused of excessive audits, with one physiotherapist reporting two aggressive audits by the company. The physiotherapist had to seek patient permission to release documents, with only two-thirds agreeing. When informing the insurer of the low consent rate, he claims the insurer threatened to force him to repay up to $300,000 in benefits.

After consulting government agencies and the Commonwealth Ombudsman, the issue was resolved. Bupa maintains that audits are conducted fairly and proportionately, adhering to legal requirements and patient privacy. Independent Dentist Network managing director Merv Saultry reported similar instances of insurer overreach, highlighting cases where insurers claimed dubious medical claims without proper qualifications to assess complex medical histories.

The Australian Private Hospitals Association has denounced this behavior as rogue, emphasizing the seriousness of patient confidentiality and the potential consequences for healthcare providers.