Group insurance fraud: the fight continues
Group insurance fraud can take many forms; however, it is often seen in the form of1:
- Fraudulent claims for care that was never received and that may involve plan members and service providers. When several plan members and service providers are involved, this is collusion. Benefits received are then shared among the fraudsters.
- False declarations, where the dates, location, type of service or amount are incorrect, in order to provide benefits to plan members. Fraudsters sometimes steal a healthcare professional’s identity.
- Unjustified and systematic medical claims in order to make the plan and the insurance premiums paid profitable.
During Fraud Prevention Month, iA Financial Group wants to make its clients aware of this problem, which significantly hampers their group insurance plan.
As a plan sponsor, it is in your interest to educate your clients about the fight against group insurance fraud so that they use their plan appropriately and honestly. The document titled Better understanding and preventing group insurance fraud was designed to help you communicate with your plan members. We invite you to forward it to them and focus on the importance of avoiding fraud and on the consequences that may result.
To learn more about fraud, you can also refer to:
- The CLHIA fraud website
- The CLHIA website with the top ten tips for consumers
- The leaflet on fraud prepared by the CLHIA
If you have any questions, please feel free to contact your iA Financial Group Advisor or Group Account Executive.1 Source: Chartered Professional Accountants Canada