Is using health or dental benefits dishonestly no big deal? The reality is that benefits fraud is a serious crime that hurts everyone. It drains critical resources from benefit plans and raises costs. This can lead to a hike in premiums, a drop in coverage and — in cases of large-scale fraud — even a cutback in staff.
Benefits fraud is the intentional act of submitting false, deceiving, or misleading information for the purpose of financial gain. This can take many forms, from backdating a disability claim to submitting a fictitious or inflated medical or dental claim.
We all have a role to play in fighting fraud. Here’s how:
Recognize the red flags
Look for these warning signs and report them if they occur:
- Feeling pressured by your health or dental service provider to get unnecessary products or procedures
- Being encouraged to claim products or services that you didn’t receive and are not covered by your plan
- Health or dental service providers who seem more concerned with the details of your insurance coverage than providing the right product or service
- Feeling encouraged to include incorrect or misleading information on a claim
- Being asked to sign a blank claim form (often completed later with misleading information)
- Health or dental service providers who use your plan membership information to charge for products and services you never received
- Being offered cash or other incentives in exchange for your policy information
Use your benefits wisely
Understanding how to use your benefits appropriately can help protect your plan against fraud.
- Familiarize yourselfwith your benefits plan and coverage limits
- Protect your information. Keep your benefits plan access information in a safe place, and don’t lend your card to anyone
- Ensure your receipts are correct and reflect the service or treatment you received.
- Don’t sign your name to blank claim forms.
- Ask questions. Don’t hesitate to question the treatment or service prescribed or given to you.
- Remember to keep your receipts. You may be asked to submit them in support of your claim.
- Alert your insurer of any providers who routinely waive your co-payment or deductible.
- Report it. If you suspect potential plan abuse or fraud, report it to your insurance company.
Fraud reporting service
Clearviewconnects is Medavie Blue Cross’s confidential fraud and ethics reporting system. This service is quick, easy and completely safe. You can file your report through this secure website or call toll-free at 1-866-876-9238. Our professionally trained, bilingual agents are available 24 hours a day.
Prevention through education
With the support of its member companies, the Canadian Life and Health Insurance Association (CLHIA), including Medavie Blue Cross, sponsors an industry initiative called the Fraud = Fraud Program. It was created to educate Canadians about benefits fraud so they can recognize it, refuse it and report it. Visit the Fraud = Fraud and the Medavie Blue Cross websites to learn how to stop benefits fraud.