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Investigation of Suspected Fraud Involving Healthcare Clinics and Providers

News Release

At Industrial Alliance, we recognize our obligation to provide efficient claims service to our plan members, and are committed to protecting plan sponsors from increased costs due to fraudulent or unwarranted claims. Following ongoing investigations by our investigative services unit and various law enforcement and regulatory bodies, we recently decided to suspend claims for expenses or services provided by certain healthcare clinics located in Brampton, Mississauga and Toronto, Ontario that may allegedly be involved in health benefits insurance fraud.

Healthcare Clinics Currently Suspended:

Name of Clinic  Effective Date of Suspension
Dynamic Footcare & Therapy
(Brampton)
 June 9, 2012
Lisa St. Doctor’s Office
(Brampton) 
 June 9, 2012
 Westwood Medical Clinic
(Mississauga)
 June 9, 2012
Malton Orthotics Clinic
(Mississauga) 
 June 9, 2012

Industrial Alliance also suspended claims for expenses or services provided by certain individuals and service providers who are under investigation by our company or by law enforcement/regulatory bodies. While such investigations remain open, the suspension may also extend to claims incurred at any associated healthcare clinics that these individuals or service providers own or operate.

In addition, Industrial Alliance suspended the associated healthcare providers from other clinic locations where they have been identified while the investigative services unit continues the investigation.

The types of provider services involved include massage therapy, physiotherapy, podiatry and chiropractic.

Detecting insurance fraud in our group plans is a key priority for us. We will make every effort to detect and investigate any suspected fraud to determine if any plan members or plan sponsors have been affected.

Any claims related to the suspended healthcare clinics or providers will not be processed, regardless of the date of service, until our investigation is complete and any investigations underway by law enforcement/regulatory bodies are complete. It is possible that a one-time exception may be granted in certain circumstances at the discretion of Industrial Alliance’s investigative services team.

We are committed to resolving this matter as soon as possible and will provide more information when it becomes available.

Communicating this information to plan members

As this information pertains directly to your plan members’ claims, we suggest that it be communicated to them promptly. We prepared some suggested wording which you may use at your discretion to provide them with this information. It can be found on page 3 of this communiqué. If you received a paper version of this communiqué and want to obtain an electronic version of the Plan Member Communication, please contact our Client Service Department at 1 877 422-6487.

If you have any questions or concerns regarding this matter, please contact your benefits advisor or your Industrial Alliance group account executive.

PLAN MEMBER COMMUNICATION

Investigation of Suspected Fraud Involving Healthcare Clinics and Providers

We were alerted by Industrial Alliance that there may be suspected fraudulent healthcare claims activity in our group benefits plan.

As a result of ongoing investigations by Industrial Alliance or by law enforcement/regulatory bodies, Industrial Alliance recently decided to suspend claims for expenses or services provided by certain healthcare clinics located in Brampton, Mississauga and Toronto, Ontario that may allegedly be involved in health benefits insurance fraud.

Healthcare Clinics Currently Suspended:

Name of Clinic  Effective Date of Suspension
Dynamic Footcare & Therapy
(Brampton)
 June 9, 2012
Lisa St. Doctor’s Office
(Brampton) 
 June 9, 2012
 Westwood Medical Clinic
(Mississauga)
 June 9, 2012
Malton Orthotics Clinic
(Mississauga) 
 June 9, 2012

The suspension also applies to claims for expenses or services provided by certain individuals and service providers who are under investigation by Industrial Alliance or by law enforcement/regulatory bodies. It may also extend to claims incurred at any healthcare clinics that these individuals or service providers own or operate. In addition, Industrial Alliance suspended the associated healthcare providers from other clinic locations where they have been identified while the investigative services unit continues its investigation.

The types of provider services involved include massage therapy, physiotherapy, podiatry and chiropractic.

This suspension means that claims related to the suspended healthcare clinics or providers will not be processed, regardless of the date of service, until all investigations by Industrial Alliance and law enforcement/regulatory bodies are complete.

At Industrial Alliance, detecting insurance fraud in group plans is a key priority. They will continue to use their best efforts to detect and investigate the suspected fraud to determine if any group plans or plan members have been affected.

Industrial Alliance is committed to resolving this matter as soon as possible and will provide more information as it becomes available.