Preventing insurance fraud

Your organization’s group insurance plan helps you take care of yourself and your loved ones by, for example, reimbursing health and dental care claims.

However, control of costs to maintain these types of plans is a constant challenge. Fraud results in high costs, which creates pressure to increase premiums and affects the availability of 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 from the group insurance plan 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 services that were never rendered
• A plan member or a group of plan members colluding with a service provider falsify claims with the intention of splitting the gains
• Health and dental service providers falsify receipts for plan members to ensure they are covered by their group insurance plan

Fraud is far from victimless

For the plan member (you)

• Reimbursement of funds
• Job loss
• Criminal file
• Fine
• Prison
• Tainted reputation in the eyes of any organization, and family and friends

For the group insurance plan and plan members (including you)

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

For the organization

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

Actions iA Financial Group is taking to minimize and prevent insurance fraud

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

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

Furthermore, iA Financial Group is 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 fraud 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’s Investigative Services

1 866 789-3938