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10 Tips to Protect your Health Benefits from Fraud

Posted by Medavie Blue Cross on November 17, 2020

Editor’s Note: Our source for this blog is CLHIA, a not-for-profit, membership-based organization that represents 99% of Canada's life and health insurance companies, including Medavie Blue Cross, and sponsors of the Fraud = Fraud public education program. The program was created to educate Canadians about the facts and costs of health and dental benefits fraud. We are publishing this blog in recognition of International Fraud Awareness Week, November 15-21.

Health benefits fraud is a real crime with real consequences. In North America alone, hundreds of millions of health care dollars are lost every year to fraud. This means higher costs for everyone – and even loss of benefits. Don’t let that happen to you, your family members and your co-workers. Here’s how you can help prevent health benefits fraud.

How to Prevent Benefits Fraud

  1. Protect your personal information, which includes your benefits plan access information.
  2. Don't let someone else borrow your card to obtain services or products.
  3. Ensure your receipts are correct and reflect the service or treatment you received.
  4. Check your explanation of benefits (EOB) provided by your insurer for services considered under your benefits plan to ensure that it reflects only those services or products obtained by you or your eligible dependents.
  5. Don’t sign your name to blank claim forms.
  6. Understand your coverage and the limits that apply under your plan.
  7. Ask questions. Don’t hesitate to question the treatment or service being prescribed or given to you.
  8. Remember to keep your receipts. You may be asked to submit them in support of your claim.
  9. Alert your insurer of any providers who routinely waive your co-payment or deductible.
  10. Report it. If you suspect potential plan abuse or fraud, report it to your insurance company.

Recognize, refuse, report fraud

Learn more how to recognize, refuse and report fraud from Medavie Blue Cross. Visit the fraud prevention page on our corporate website to learn more about our process and the role you can play in fighting benefit plan fraud and abuse.

Use our fraud and ethics reporting service

ConfidenceLine is our confidential ethics reporting system. This service is quick, easy and completely safe. You can file your report through this secure website or by calling toll free at 1-866-876-9238. Our professionally trained, bilingual agents are available 24 hours a day.

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