Report or Prevent Insurance Fraud
Here is a helpful document to share with them: Better understanding and preventing insurance fraud
Fraud occurs when information is deliberately withheld or misrepresented so as to ensure the payment of an insurance claim from which a claimant, a service provider or another party stands to benefit financially.
iA Investigative Services are available to anyone who wants to report potential fraud or abuse that may be going on within their group plan. These services are completely confidential.
When using our services, please be sure to include all pertinent information, including the name(s) of the offender(s), dates, and a description of the activity or abuse. No return contact will be made unless requested. If you leave your name, the information you provide could be disclosed under certain circumstances.
There are a number of organizations dedicated to the fight against fraud. Among them, the Canadian Life and Health Insurance Association (CLHIA), of which iA is a member, and PhoneBusters offer their services to consumers.
Canadian Life and Health Insurance Association (CLHIA)
iA Financial Group is a member of this organization whose mandate is to detect, prevent, investigate and prosecute individuals engaging in healthcare fraud.
You may contact them to report fraud by visiting their website.
Phone Busters is a national anti-fraud call centre jointly funded by the Ontario Provincial Police (OPP), the Royal Canadian Mounted Police (RCMP) and the Competition Bureau. Canadians can call Phonebusters to report incidences of fraudulent activities, including telemarketing fraud and identity theft, as well as to learn more about how to protect themselves from fraud.
To contact PhoneBusters, call 1-888-495-8501 or visit the website.
- Never leave a blank claim form bearing only your signature with a healthcare provider. Complete your own claim forms and mail them directly to us.
- Do not give anyone your policy and certificate numbers or any other information about your benefit plan. Be wary of aggressive marketing programs.
- Review your Explanation of Benefits statement to verify that the information is correct. You may access it online via our secure website, My Client Space.
- Check your Claims History Profile regularly using your secure member access code and password. Ensure that the expenses were incurred by you and/or your family members.
- Ensure that the treatments you receive are medically necessary and have been recommended for you and/or your family members.
- Never submit a claim before you have received the medical or dental treatment, service or product.
- Ensure that the medical or dental practitioner providing the service has the appropriate qualifications to provide the service and meets the requirements of your plan.
We take our role seriously.
iA Financial Group share the best practices of our industry partners at the Canadian Health Care Anti-Fraud Association (CHCAA) with regard to effective handling of problematic claims. By addressing fraud collectively, we enhance the quality of care for our plan members.
To ensure effective and efficient investigative services, we:
- Take appropriate measures to identify providers involved with problematic claims
- Initiate better business practice inspections of various service providers in order to put a stop to questionable practices
- Compile the data obtained from a sampling of claims in order to use this information to detect atypical situations on a larger scale
- Seek input from clinical experts to help us handle contentious claims given the increasing complexity of healthcare as a whole and the administration review process
By doing so, we:
- Reduce the negative economic impact of fraudulent claims on plan costs by making adjustments to our fraud detection programs
- Mitigate the risk of inappropriate care, which is a side effect of healthcare fraud and abuse
- Offer quality and diligent service to the vast majority of plan members who file legitimate claims