Tracking estimated financial losses to complex billing errors, sharp practices, waste and intentional fraud across Medicare, NDIS, and aged care — and the accountability (or lack thereof) that follows.
A mix of confusing billing rules, non-compliance and intentional fraud (ghost patients, upcoding). The 2023 Philip Review confirmed this leakage is endemic, heavily driven by complex item codes — the majority is non-compliance, not criminal.
Systemic non-compliance
NDIS exploitation & syndicates
Up to $6B/yr
ACIC estimates massive losses to a combination of "sharp practices" (price-gouging NDIS clients) and organised crime syndicates billing for services never delivered to vulnerable Australians.
Organised crime + price gouging
Aged care neglect & billing failures
$600M+ est.
Providers billing for care not delivered. The Royal Commission (2021, 148 recommendations) exposed systemic neglect funded by public money. Aged care now makes up 30% of all integrity tip-offs to the Department of Health.
Billing failures + neglect
PBS & pharmaceutical over-claiming
$200M+ est.
Prescription padding, duplicate dispensing and kickback-adjacent arrangements between prescribers and pharmacies. ANAO found that financial losses here are not even being formally quantified — the real figure is unknown.
Under-quantified leakage
Health identity theft & data fraud
15% of all data breaches
Healthcare was the #1 most-breached sector in Australia (OAIC Jan–Jun 2023). Stolen Medicare card details are used to claim fraudulent benefits, access prescription drugs or commit insurance fraud.
Identity-enabled fraud
Pathology & imaging over-servicing
$400M+ est.
Unnecessary tests ordered to maximise Medicare claims. Inappropriate referral arrangements between labs and clinics flagged in five separate government audits between 2016 and 2021 — and repeatedly not acted upon.
Over-servicing — flagged 5 times
Systemic gaps — tap any node to learn more
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Known penalties — fines as a lump sum
LiveBetter Services — disabled woman (Kyah Lucas) died under their care (2024)
$1,800,000 civil fineNo jail
Australian Foundation for Disability — resident drowned in bathtub under care (2023)
$400,000 fineNo jail
Angela Rose — Medicare receptionist, $253K fraudulently claimed over time
Criminal conviction18 months jail
NDIS Fraud Fusion Taskforce — 50 individuals referred to court (2024)
$60M+ recoveredProceedings ongoing
Aged care providers — maximum civil penalty under new Aged Care Act 2025
Up to $3,300,000No jail — criminal penalties removed
NDIS banning order breach — new criminal penalty regime 2025
Was $1,600,000 civilNow up to 5 yrs jail
False or misleading information in NDIS registration applications
Up to $3,300,000Criminal referral possible
* The Aged Care Act 2024 originally included criminal jail penalties for executives and board members. These were removed from the final Act (passed December 2024) following lobbying from the sector and unions. Only civil penalties remain for aged care — and those civil penalties can be covered by statutory liability insurance policies, limiting their deterrent effect.
Jail time accountability tracker
Custodial sentences vs. estimated leakage
Bar = approximate % of maximum possible penalty actually applied per category. Note: the $8.25B figure includes non-compliance and waste, not only criminally recoverable fraud — the comparison illustrates the accountability gap, not a literal clawback rate.
Note: total leakage includes non-compliance & waste — not all is legally recoverable. The figure illustrates the scale of the gap between what is detected and what is lost.
What advocates say should also be tracked
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Whistleblower case tracker
58% of Asia-Pacific health leakage is found via tips. A public tracker should map how many whistleblowers faced retaliation vs. how many tips led to formal investigation or prosecution.
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Provider re-registration monitor
Track deregistered NDIS and aged care providers re-entering under new ABNs. A known structural gap — the NDIS Commission has acknowledged it cannot pursue every case.
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Penalty proportionality index
Compare civil fines imposed against the scale of the organisation's revenue or the estimated financial gain from non-compliance — to show whether fines create any real deterrent.
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Care gap correlation tracker
Link leakage-drained budgets to measurable consequences: surgical wait times, unfilled home care packages, understaffed aged care facilities, and NDIS plan shortfalls.
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Geographic leakage hotspot map
Fraud Fusion Taskforce operational data shows leakage clustering in specific metro areas. A postcode-level map would show where integrity failures are most concentrated.
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Donations vs. policy outcomes tracker
Cross-reference aged care and NDIS peak body political donations with legislative outcomes — for example, the lobbying campaign that successfully removed criminal penalties from the Aged Care Act 2024.