About the whistleblower process
This process provides a formal reporting process to PHIAC for whistleblowers. This process was endorsed by the Council and implemented on 16 July 2009.
About being a whistleblower
For the purposes of this policy, whistle blowing is defined as the deliberate, voluntary disclosure of individual or organisational malpractice by a person who has, or had, privileged access to data, events or information about an actual, suspected or anticipated wrongdoing within or by an organisation that is within its ability to control.
A whistleblower is a person who reports on, or brings to public attention this information, especially from within an organisation.
Through your dealings with a private health insurer, or as a result of your employment in the private health insurance industry, you may become aware of information that leads you to believe there has been misconduct by an insurer or its staff which gives you concern about the way that the insurer is meeting its prudential obligations. Such misconduct may include:
- corrupt or fraudulent activity
- substantial mismanagement
- failure to comply with legal requirements
- dishonest or unethical behaviour by an individual within the organisation, that would, if proven constitute a criminal offence or warrant regulatory action.
All information that is provided in good faith by a member of the public is appreciated as it assists the Council to carry out its functions in a more effective and efficient manner.
The Council will comply with all applicable laws and practices and is committed to protecting whistleblowers. Whistleblowers will receive feedback, to the extent allowable, and all reports will be kept confidential and secure.
The Council will not inform anyone outside the regulatory field about your concerns, unless you authorise us to do so, except to the extent we are required to by law. Your personal information will be protected from disclosure except where you authorise its release.
The Council notes that the act of whistle blowing should not shield whistleblowers from the reasonable consequences flowing from any involvement in improper conduct. A person’s liability for his or her own conduct is not affected by the person’s disclosure of that conduct.
General complaints about a fund or insurer
If you have a general inquiry or complaint related to how a fund handles your personal affairs (ie about your private health insurance policy arrangements), you should in the first instance contact the insurer to resolve the matter. Such complaints should be made in writing to ensure that your concerns are properly recorded by the insurer.
Matters not related to prudential obligations such as complaints relating to a health benefit, a broker, a hospital, a medical practitioner, a dentist or other practitioners (as long as the complaint relates to a private health insurance policy), should, in the first instance be directed to the health fund or the body you are complaining about. Failing this, the complaint can be made through the Private Health Insurance Ombudsman. Details can be obtained from www.phio.org.au or by phoning 1800 640 695.
What PHIAC can tell you
While you can expect the Council to take seriously the information you provide, section 323 of the Private Health Insurance Act 2007 restricts the information PHIAC can disclose to you or to the public about the entities we regulate and about the action that may be taken as a result of the information you provide to the Council, unless formal enforcement action is taken.
What happens to your information?
Verbal information – will be recorded in a report by the person you speak with and referred to the Director, Industry Analysis and Compliance. Generally, verbal complaints will only be followed up if any issue is identified in the information supplied which requires further investigation.
Written feedback and information – including both email and hard copy correspondence: this will be referred to the Director, Industry Analysis and Compliance to consider and investigate the allegations. All written complaints will be reviewed, addressed and responded to in a reasonable timeframe depending on the nature and complexity of the information.
In certain cases where issues of concern appear to have been identified, we may contact you to obtain further details.
Why is PHIAC collecting this information?
PHIAC collects information provided by the public which can assist us in our regulatory role. Where the information is about PHIAC, we are committed to improving the performance of our functions. The information you provide will not be disseminated outside PHIAC except with your permission or as authorised by law.
PHIAC will accept information anonymously. However if you are providing information to PHIAC it is preferable that you provide your contact details to assist in any investigation into the matter.
When anonymous information is received by PHIAC it is given to the Director, Industry Analysis and Compliance to investigate the allegations and determine the appropriate course of action to take. That course might include further investigation and/or referral to the PHIO.
PHIAC will comply with all applicable laws and practices and is committed to protecting whistleblowers. Due to the legal provisions that restrict the type of information PHIAC may disclose to the public, the actions taken in respect of a complaint made by a whistleblower may not be visible to the public unless formal enforcement action is taken that would otherwise be in the public eye.