Preventing group insurance fraud and abuse
As a responsible insurer, we are committed to doing everything we can to ensure the long-term viability of group insurance plans, notably our proactive approach to prevent fraud and abuse.
Fraud and abuse in group insurance generate significant costs that put pressure on premiums and on the availability of coverage, to the detriment of plan administrators, plan members and their families.
In addition to compiling and analyzing data from all claims in order to detect any anomalies and take action, our Investigative Services teams ensure the integrity of the ecosystem that provides health and dental services and care.
- We regularly investigate providers and clinics, either randomly or following the identification of a problem, to ensure their probity and the rigour of their business practices.
- We audit professional associations to verify the quality of the supervision of providers who are members (criteria for access to the profession, continuing education, discipline, etc.).
If we observe deficiencies or inappropriate practices, we may, depending on the severity of the situation, discontinue coverage for the care and services of providers, clinics and professional associations whose business practices are inconsistent with our standards.
When we discontinue coverage for a provider, clinic or association, we stop reimbursing plan members for expenses incurred with them.
Last year, we investigated approximately 2,500 providers, clinics and associations. As a result of these audits, we stopped covering the care and services of over 900 of them.
To avoid unpleasant surprises, we encourage plan members to check beforehand whether we reimburse expenses incurred with the provider with whom they wish to do business. It's easy with the Provider search tool available in My Client Space and iA Mobile.
If in doubt, you can verify whether we cover a provider's care and services by contacting our Customer Service at 1-877-422-6487 or by email at firstname.lastname@example.org.
Suspicious activities can be reported to our Investigative Services at 1-866-789-3938 or by email at email@example.com.
For more information, refer to the Better understanding and preventing insurance fraud document.
If you have any questions or need more information, please contact your advisor or your iA Financial Client Relationship Manager.