Benefits Fraud – How can you recognize it?

Insurance & Taxes

Can you recognize benefits fraud?

Insurance fraud is a growing concern and we need your help to tackle this issue. It may seem like a victimless crime but benefits fraud impacts everyone; affecting the price of insurance premiums.

The Co-operators has partnered with the Canadian Life and Health Insurance Association Inc. (CLHIA) to raise awareness and educate consumers about how to recognize benefits fraud.

Benefit fraud occurs when a person intentionally submits false information about medical or dental treatment to their benefits provider. The CLHIA has provided some great tips on how to recognize benefits fraud on their website.

Our goal is to ensure that your plan continues to support the health and well-being of your plan members and their families while remaining sustainable and cost effective.

While most people are honest and claim legitimate expenses, we still need to be thorough in our review and adjudication of claims; ensuring they meet the guidelines of your benefits plan. While our claims adjudicators are well trained to spot irregularities in claim activity and our audits provide additional protection, educating our members is key in our efforts to fight benefits fraud.

If you suspect fraud, contact: The Co-operators Group Client Service Centre:
In total, private insurers paid out $34 billion in health claims last year. Estimates for the number of fraudulent claims range from 2 to 10%, meaning between $600 million and $3.4 billion is being stolen annually. ~Canadian Life and Health Insurance Association

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