Welcome to the health provider tip-off form

Page last updated: 08 October 2019

Completing this form

When completing the form, please remember it doesn't matter how much or how little information you have, every detail is valuable. It should only take a few minutes of your time to complete.

This form allows you to provide information about a health provider, an organisation, or their employees. Should you require more information about what can be reported on this form please refer to Health provider related tip-offs page

Let's start

Part 1
Part 2

(eg Dr John Doe, Family Pharmacy etc)

(eg the address of the practice or the pharmacy; the date if you know it)

(an identification/reference number could be a provider number, pharmacy approval number or an ABN - you may be able to find these on invoices, medicine labels or other documentation)

Almost done

Part 3

Your details (you can remain anonymous; however, providing your details will enable us to contact you if more information is needed. If you do provide us with your contact details, we will not reveal your identity in the course of our enquiries - See our privacy notice below.)

Documents to support your tip-off?

If you have electronic documents you would like to attach to support your tip-off, please upload up to 5 related files here:

If you have hardcopy documents, you can post them to us at Provider Benefits Integrity Tip-Offs, MDP 659, GPO Box 9848, Canberra ACT 2601.

  Remove filePlease only select a file of the correct type
  Remove filePlease only select a file of the correct type
  Remove filePlease only select a file of the correct type
  Remove filePlease only select a file of the correct type
  Remove filePlease only select a file of the correct type


Please select up to 5 files (Files can be of type doc, docx, xls, xlms, pdf or jpg)
and have a maximum size of 25MB in total for all the files.

Declaration

Privacy Notice

Your personal information is protected by law, including the Privacy Act 1988, and is being collected by the Australian Government Department of Health for the purposes of investigating, assessing and responding to fraud or suspicious activity by health providers against the Australian Government's health related programmes.

You can get more information about the way in which the Department of Health will manage your personal information, including our privacy policy on our privacy notice page.