Blog No. 171 - Australian Competition and Consumer Commission – Part 5: 10 February 2025

After providing hope that it would investigate the crimes committed by the health insurers, the ACCC ceased all investigation of the health insurers on the 14th of July 2022.

The Australian government changed because of the Australian elections held on the 22nd of May 2022.

I theorise the election of a new government was the major reason why the ACCC stopped its pursuit of the crimes committed by the health insurers.

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Margaret at Glendalough, Ireland. 9th of September 2019.

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Gorgeous scenery at Glendalough, 9th of September 2019.

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ACCC Letter Dated 15 July 2022

The ACCC reply to my appeal sent on 14 July 2022 was immediate.  I got an email and a letter from the ACCC at 11.43 am on 15 July.  The email said this.

Dear John  Thank you for your email.   We confirm this additional information does not change our view as to the application of the Australian Consumer Law to the allegations raised in your complaint, and we will proceed to close our investigation. We attach a letter which provides an explanation for the decision to conclude our investigation. We would be happy to have a call with you and Margaret to discuss this further at a time that suits you. If you are interested, please let us know if you have any availabilities for a call in the week commencing Monday 25 July.  We have also engaged with other government agencies responsible for private health insurance matters regarding the issues raised in your complaint. Would you be comfortable for us pass on the additional information you have provided us to these agencies?  Kind regards Sita   Sita McTavish Senior Investigator | Enforcement - Southern | Consumer and Fair Trading Division  Australian Competition & Consumer Commission

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The email from the ACCC referred to a letter attached to the email.  This is the ACCC letter attached to the email.  It gives the official ACCC reasons for abandoning the investigation into the health insurers.

Our ref: CS1050600  Contact officer: Sita McTavish  Contact phone: (03) 9658 6437  July 2022  John Hankin and Margaret Redden  By email Dear John and Margaret  ACCC investigation into your complaint regarding Hospitals Contribution Fund of Australia Limited and other private health insurers We refer to our previous communications in relation to the Australian Competition and Consumer Commission’s (ACCC) investigation into your complaint regarding Hospitals Contribution Fund of Australia Limited (HCF) and other private health insurers. Our investigation considered the allegation that HCF and other private health insurers are unlawfully refusing to accept claims for reimbursement for the services provided by Lift Cancer Care Services (Lift) to its patients in contravention of the Australian Consumer Law (ACL).  We are writing to advise that we have considered your complaint and decided to close our investigation and take no further action at this stage. This decision was based on careful consideration of the information available to the ACCC, including your letters of 22 March 2022, 9 May 2022, 20 June 2022 as well as the copies of your correspondence with HCF, and our inquiries with other government agencies responsible for the administration and regulation of the private health insurance industry. We consider the issues raised in your complaint result from a dispute between HCF (and other private health insurers) and Lift as to the scope of the legislation governing private health insurance benefits. We do not consider investigation under the Australian Consumer Law is warranted at this time. We also understand HCF has reimbursed your past claims for Lift’s services and stated it will honour claims made in future, including those submitted directly by Lift on Margaret’s behalf. The ACCC will monitor future complaints related to private health insurers and we will continue to take concerns raised by consumers in this area seriously, and we may reopen this investigation at any time. Thank you again for your assistance with our investigation. We were very sorry to hear of the difficulties Margaret has been facing with her health. We wish you and Margaret all the best for the future. If you have any further questions about this matter, please contact Sita McTavish, Senior Investigator, on (03) 9658 6437 or Sita.McTavish@accc.gov.au. Yours sincerely  Madelaine Holt General Manager (A/g)  Enforcement Southern  Consumer and Fair Trading Division

The official reasons for the ACCC deciding to revert into “sleep mode” are in this paragraph.

“We consider the issues raised in your complaint result from a dispute between HCF (and other private health insurers) and Lift as to the scope of the legislation governing private health insurance benefits. We do not consider investigation under the Australian Consumer Law is warranted at this time. We also understand HCF has reimbursed your past claims for Lift’s services and stated it will honour claims made in future, including those submitted directly by Lift on Margaret’s behalf.”

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The official reasons amounted to this.

ACCC had consulted with “other government agencies responsible for the administration and regulation of the health insurance industry.

The ACCC had accepted assurances from the corrupt Ombudsman and corrupt Department of Health that all was lawful.

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ACCC had accepted assurances that our complaint centred on “a dispute” between the health insurers and Lift about the proper interpretation of the legislation.

ACCC was too lazy to actually investigate if the health insurers were breaking the law.  All lawbreakers claim they are acting legally.

ACCC accepted claims by the Health Department and the Ombudsman that because there was a “dispute”, no action was necessary.  This was rubbish.  The health insurers were refusing to pay because they knew government agencies were refusing duty.  Legally speaking, ACCC, Health Department and the Ombudsman had a duty to investigate whether the law permitted the insurers to refuse payment.  If the law did not, the agencies had a duty to act.

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HCF had reimbursed us for our unpaid claims and had agreed to pay all future claims submitted to Lift Cancer Care Services.

The insurers have promised to pay Lift in future so we don’t have to look for any other crimes they may have committed.

Rubbish.

I had already given ACCC clear evidence that HCF had engaged in false and misleading conduct by “disappearing” most of our claims for services provided to Margaret by Lift.  I am sure this conduct was criminal – but somehow, the ACCC decided no further investigation was needed.

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All of my dealings with Sita McTavish had been sympathetic and professional, but the letter was signed not by Sita but by Madelaine Holt.  The decision to refuse to investigate was not made by Sita but at a level above Sita – perhaps by Madelaine Holt, but perhaps Madelaine signed the letter under orders.

Why do I think this? It will be made clear soon.