Preventing group insurance fraud

Controlling costs to maintain such a plan is a constant challenge. Fraud results in high costs, which creates pressure to increase premiums and affects coverage options.

Group insurance fraud affects everyone. By learning how to properly use your plan, you will be better able to recognize and help prevent fraud.

Different facets of group insurance fraud

Fraud occurs when information is deliberately withheld or misrepresented to obtain a reimbursement to the financial benefit of a plan member, a service provider or another party.

By whom and how is fraud usually perpetrated?

Here are a few examples:

• A plan member claims expenses for a service that was never provided
• A plan member colludes with a service provider to falsify a claim with the intention of splitting the gains
• A service provider falsifies a receipt for a plan member to ensure it is covered by their group insurance plan

Fraud is not a victimless crime

For the plan member (you), it could lead to:

• An obligation to reimburse any amount illegitimately obtained
• A job loss
• A criminal record
• A fine
• A prison sentence
• A tainted reputation in the eyes of any organization, family and friends

For the group insurance plan and plan members (including you), it could lead to:

• Higher group insurance premiums
• Reduction or loss of coverage (depending on the severity of the fraud)

For the organization, it could lead to:

• Additional costs that may cause changes to the group insurance plan

Actions iA Financial Group is taking to minimize and prevent fraud

The mandate of the iA Financial Group Investigative Services team is to:

• Use service provider inspection best practices to put a stop to suspicious billing and/or claims schemes
• Compile and analyze the data obtained from all claims to detect unusual situations
• Seek input from clinical experts to help handle contentious claims

iA Financial Group is also a member of the Canadian Life and Health Insurance Association (CLHIA), which helps Canadians recognize fraud, understand how to avoid becoming involved in fraudulent activities and increase awareness that falsifying a claim is a crime and can have real consequences.

Be part of the solution

If you witness or suspect a fraudulent act, either by a colleague or a service provider, you can easily, and in full confidentiality, report it to iA Financial Group’s Investigative Services.

iA Financial Group Investigative Services

1 866 789-3938