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Update: Investigation of Suspected Fraud Involving Healthcare Clinics/Medical Suppliers

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. As mentioned in our October 2012 communiqué, our investigative services unit conducts ongoing investigations in collaboration with law enforcement/regulatory bodies in order to identify providers involved with problematic claims. As a result of these investigations, we recently decided to suspend claims for expenses or services provided by the following healthcare clinics/medical suppliers in Mississauga, Ontario that may allegedly be involved in health benefits insurance fraud:

  • Mississauga Medical Shoe Supply Inc. 
  • Rockwood Medical Foot Centre Inc.

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

The types of expenses involved include custom-made orthotics, orthopaedic shoes, compression stockings and chiropody/podiatry services.

Detecting insurance fraud in our group plans is a key priority for us. We remain committed to the detection and investigation of suspected fraud to determine if any plan members or plan sponsors have been impacted.

Any claims related to the suspended healthcare clinics/medical suppliers or providers will not be processed, regardless of the date of service, until our investigation and all investigations underway by law enforcement/regulatory bodies are complete. In addition, claimants may be asked to provide further supporting documentation and/or to present themselves for an independent medical examination once the investigation is complete to ensure that only legitimate claims are paid.

We encourage plan members to contact our investigative services by phone at 1-888-789-3938 or by email at IAInvestigativeServices@inalco.com to report any concerns of potential fraud or abuse with respect to these healthcare clinics/medical suppliers that may be taking place within their group plan

We are committed to resolving this matter as soon as possible and will provide more information when it becomes available, in accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA).

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 have 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

Update: Investigation of Suspected Fraud Involving Healthcare Clinics/Medical Suppliers

As a follow-up to the communication provided to you in October 2012 regarding suspected fraudulent healthcare claims activity in our group plan, we were informed by Industrial Alliance that additional actions were undertaken to further counteract healthcare fraud.

As a result of ongoing investigations by Industrial Alliance and/or by law enforcement/regulatory bodies, Industrial Alliance has recently decided to suspend claims for expenses or services provided by the following healthcare clinics/medical suppliers in Mississauga, Ontario due to potential fraudulent healthcare claims activity:

  • Mississauga Medical Shoe Supply Inc. 
  • Rockwood Medical Foot Centre Inc.

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

The types of expenses involved include custom-made orthotics, orthopedic shoes, compression stockings and chiropody/podiatry services.

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

In addition, claimants may be asked to provide further supporting documentation and/or to present themselves for an independent medical examination with regard to any claim once the investigation is complete to ensure that only legitimate claims are paid.

You are also encouraged to contact Industrial Alliance’s investigative services by phone at 1-888- 789-3938 or by email at IAInvestigativeServices@inalco.com to report any concerns of potential fraud or abuse with respect to these healthcare clinics/medical suppliers that may be taking place within your group plan.

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 in accordance with the Personal Information Protection and Electronic Documents Act (PIPEDA).