Scheme fraud

Preventing fraud in Queensland’s National Injury Insurance Scheme (Scheme) keeps Compulsory Third Party (CTP) insurance premiums affordable for motorists and enables our scheme to focus on supporting people who genuinely require lifetime treatment, care and support as a result of their accident.

What is Scheme fraud?

Scheme fraud is any dishonest or deceptive conduct intended to gain an improper benefit from the Scheme such as payments or supports.

Examples of Scheme fraud may include:

• Exaggerating the severity of an injury or falsifying medical evidence to qualify for scheme entry
• Dishonestly making a claim for treatment, care and support expenses incurred
• Deliberately misleading healthcare professionals regarding improvement in order to maintain a high level of care or supports
• Providing false or misleading statements or documentation i.e. identity fraud
• A participant and service provider colluding to financially benefit from the Scheme
• A provider charging for services not provided or overcharging for services
• Establishing a fake business to claim for services provided to a known participant.

What conducting fraud may mean for you

If you make a fraudulent claim, you may be prosecuted. Having a criminal conviction against your name can affect your job prospects or cause you to lose your job entirely. You may also have to pay back a large amount of money. The maximum penalty if found guilty of an offence involving fraud is 500 penalty units (a fine) or five year’s imprisonment under s533 of the Criminal Code Act (Qld) 1994.

Our role

We take fraud affecting the Scheme seriously. When we receive a report, we assess the information provided and may use data checks and other enquiries to help determine whether further action is needed. We work with insurers and may share information with the Motor Accident Insurance Commission (MAIC), Queensland Police Service and other regulators where required or permitted by law. To view case studies of fraudulent activity resulting in prosecution visit the MAIC website.

Report suspected fraud

You can report suspected fraud in the Scheme if you think a person or business has provided false information, claimed for services not provided, or is otherwise trying to get an improper benefit.

Need help?

If you can’t use this online form, you can report by email at governance@niis.qld.gov.au or by phone on 1300 607 566 (leave a message for our Governance team). You can also choose to report anonymously.

If your report is about suspected fraudulent medical documents, we may need to share the information with Queensland Police Service and Services Australia.

If your report also relates to a CTP insurance claim, we will share the information with MAIC for investigation under the Motor Accident Insurance Act 1994.

For privacy reasons, we cannot confirm whether the person you are reporting is a participant of the Scheme or has made a CTP claim, and we cannot provide updates about any investigation.

Report fraud form: Full collection notice

The National Injury Insurance Agency, Queensland (NIISQ Agency) collects personal information, including sensitive information, about individuals who are the subject of fraud reports. This information is collected from members of the public through this online form for the purpose of detecting, investigating, and managing suspected fraud relating to the Scheme.

If you choose to provide information, please ensure it is accurate and relates directly to your concerns about the potential fraud. We will take all reasonable steps to protect your identity including storing your details separately from the information you provide about the suspected fraud and restricting access to authorised officers only. We will not disclose your identity unless required or permitted by law.

The information you provide will be used by authorised officers within NIISQ Agency and may be disclosed to the Motor Accident Insurance Commission (MAIC), law enforcement agencies, integrity bodies, or other government entities where required or permitted by law.

All personal information, including sensitive information, is handled in accordance with the Information Privacy Act 2009 and the Queensland Privacy Principles including the requirement to protect the information from unauthorised access, and to ensure it is accurate, relevant and not misleading. For more information about how we manage personal information and how to make a privacy complaint, please refer to Our privacy policy. You can also contact our privacy team at privacy@niis.qld.gov.au if you have any questions.

In investigating this claim, an authorised officer may wish to contact you directly about the matter if you have chosen not to remain anonymous.