The TAC is committed to protecting the funds and other assets placed under its control and protection for the benefit of the people of Victoria.  Fraud represents potential risks to these funds and assets.

The TAC will not tolerate fraudulent or corrupt activities against its interests and will vigorously pursue parties engaged in such practices or attempting to do so.

How to make a report

Fraud and the TAC

Read the TAC Compliance and Enforcement Policy

Prosecutions

How to make a report

Should you wish to make a report of fraudulent behaviour or other breaches of the TAC legislation, please contact the TAC's Fraud and Compliance Group by emailing Fraud_Compliance@tac.vic.gov.au or by calling 1300 654 329.

Fraud and the TAC

Fraud is dishonest activity or potential financial loss to the TAC  including theft of moneys or other property by employees or persons external to the TAC. This includes:

• the deliberate falsification, concealment or destruction of documentation
• falsified documentation used or intended for use for a normal business purpose
• the improper use of information or position.

The following are examples of fraudulent behaviour:

• knowingly submitting a false claim
• providing false information
• working whilst on compensation benefits
• altering a medical certificate
• submitting false travel expense claims
• claiming for services which were not given (service providers) and
• providing false invoices, medical certificates.

Actions that may be taken by the TAC

Following an investigation, the TAC may:

• Commence criminal proceedings under relevant provisions of the TA Act or relevant criminal legislation
• Issue a letter of caution to the person
• Determine whether civil action should be taken to recover compensation amounts overpaid
• Refer the matter to the Victoria Police, the Coroner, the Office of Public Prosecutions (OPP) or another body (including professional or trade regulatory bodies such as the Australian Health Practitioner Regulation Agency (AHPRA) and the Legal Services  Board) or
• Take no further action.

Any employee found to have engaged in, or concealed any such behaviour, may be disciplined, and their employment may be terminated.

TAC billing review program

The TAC has a Billing Review Program to ensure that payments for services provided to TAC clients are reasonable and appropriate. For more information please refer to:

• Billing Review Program - Information for Medical Practitioners PDF, 0.17MB
• Billing Review Program - Information for Medical Practitioners DOC, 0.75MB

• Billing Review Program - Information for Allied Health Providers PDF, 0.18MB
• Billing Review Program - Information for Allied Health Providers DOC, 0.75MB

• Billing Review Program - Information for Dental Providers PDF, 0.16MB
• Billing Review Program - Information for Dental Providers DOC, 0.82MB

2021/22 - Disrupting Fraud

By constantly evaluating emerging risks and using contemporary analytical methods, models, intelligence gathering and reporting techniques, the TAC is better equipped to identify potential fraud and claim anomalies at its origin.  

The early identification of vulnerabilities, due to changes in service and benefit provision created by the global pandemic, has allowed the Forensics Group to  expand our fraud risk assessments, improve our proactive fraud detection capability and create diverse opportunities to enhance our monitoring activities.

Telehealth, clients and providers supplying false information to the TAC, provider billing anomalies and clients potentially returning to work without notifying the TAC have all contributed to an elevated fraud risk profile during the second year of the pandemic.

Through our continuous monitoring, detection and response enhancements, significant growth has occurred in the number of reviews, investigations and prosecutions being initiated, effectively disrupting fraudulent behaviour and providing both a general and specific deterrence to fraud being committed against the TAC.

Throughout 2021-2022, the following enforcement action was taken:

• Twenty (20) prosecutions were finalised through the Magistrates Court. All cases resulting in a finding of guilt having a total amount in restitution being awarded to the TAC of $683,209.
• Thirty-Two (32) matters are currently before the courts where TAC is alleging fraud against the scheme totalling $1,521,763.
• There are a further Four (4) matters where prosecution has been endorsed with two matters referred to Victoria Police due to the fraud amount and statute of limitation issues and two matters awaiting service of charges totalling $450,089.
• A further Nine (9) matters relate to TAC clients wanted on Warrant with charges yet to be served, with a total fraud amount outstanding of $373,510.

The total alleged fraud against TAC before courts or awaiting service of charges is $2,345,362.

There are a further Eight (8) matters currently being reviewed for legal advice with a view to prosecution or other enforcement action, with a potential fraud amount of $234,426.

Cases that have not met the prosecution threshold are dealt with through the TAC’s principal means of achieving prompt voluntary compliance. Seventeen (17) warning letters were sent for breaches of the Transport Accident Act 1986 relating to fraud and providing false information to the TAC by clients, incorporating demands for reimbursement where appropriate.

Billing Review Program

During the 2021–2022 financial year, the TAC enhanced their proactive monitoring of service provider billing behaviour and adjusted their control landscape, which was supplemented by internal business referrals and information received from the public.

This program focuses on ensuring the invoicing supplied by service providers and the subsequent payments made are an accurate reflection of the services provided to TAC clients. For this reporting period, continuous monitoring activities and reviews were undertaken on more than 200 providers across a broad range of disciplines including Surgery, Physiotherapy, Pharmacy, Occupational Therapy and General Practitioners.

Prosecutions