PHA chief executive Rachel David has urged Australians to examine their medical bills for any service not attached to a Medicare item or for statements on bills labelled as “booking” or “administrative” fees.

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“If it says that it’s a separate fee that Medicare or the health insurance fund won’t pay, that is a red flag,” David said.

“I would suggest that the first thing that the person does is call their health fund to ask what it means.”

PHA says health insurers have been preparing for an influx of calls from concerned or confused customers trying to determine if they have been overcharged.

Regarding Medicare overbilling, David urged patients to check their claims history on Medicare via their MyGov account. This details what services have been charged to Medicare.

“You want to make sure that that’s matched up with the services that you actually received,” David said.

David said that when a service has been bulk-billed, consumers should not be charged anything extra for that consultation.

“If you have been charged extra then that is against the law, and you need to contact Medicare to notify them,” she said.

If patients believe they have been a victim of fraud, they should report it to Medicare.

David said PHA had heard distressing accounts from people who had been told on the day of their surgery that they would be stung thousands extra in additional fees they were unaware of.

This includes instances where a specialist has added an assistant without telling a patient in advance.

“We’ve been told some absolutely terrible stories,” she said.

“Raising a charge while a patient is under duress is unacceptable … if a patient challenged that under consumer laws I think they probably win.”

PHA said one survey by a major health fund recently found about 31 per cent of its more than 4000 members had potentially been ripped off after paying a fee, despite no-gap arrangements.

The health fund is still working through the cases to determine the extent of overbilling.

According to the whistleblower complaint, during her employment at a Mornington Peninsula medical clinic – which spanned a decade – about 90 per cent of patients were stung with out-of-pocket costs, despite the no-gap-fee arrangements.

These hidden fees ranged from $500 to $5000, she alleged.

“I brought this concern up to my superior, who told me not to worry because they have been doing this for more than 10 years and everyone including the specialist surgeons we look after are doing it. ‘It can’t be wrong if anyone is doing it!’” the whistleblower, who is not identified, wrote in the confidential document seen by The Age.

How to report potential fraud to Medicare:

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