1 minute read
Nutrition Month
from OTG online edition
by lazarusbleau
BENEFITS FRAUD
REAL CRIME. REAL CONSEQUENCES.
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As part of the Canadian life and health insurance industry’s anti-fraud awareness campaign Fraud=Fraud, a 2018 survey commissioned by Environics Research Group revealed that 75% of insured Canadians surveyed think that the main consequence of benefits fraud is having to pay higher premiums or reimburse claim payments, and only 25% believe they could lose their jobs. The truth is, you could lose everything, and even end up in jail.
WHAT DOES BENEFITS FRAUD LOOK LIKE? Benefits fraud occurs when you intentionally submit false or misleading information on your health or dental benefit claim for the purpose of financial gain, and it can take many forms. Some examples include: • Billing for health or dental services that were never received • Submitting the same claim to multiple insurers to double your reimbursement • Letting someone not covered by your plan use your benefits.
WHAT CAN YOU DO? First, learn how to recognize the signs of fraud. Benefits fraud is not always easy to spot, especially when a trusted coworker, friend, family member, health, or dental service provider suggests it. Warning signs include feeling pressured by your service provider to get unnecessary products or procedures, or being encouraged by a colleague to visit a service provider offering cash or other incentives in exchange for your policy information. Second, refuse to participate. The adage “if it seems too good to be true it probably is” applies here. Start by familiarizing yourself with your benefits plan and the limits of your coverage, don’t lend your card to anyone and be sure you understand the treatments, services, and products being prescribed to you. When in doubt, push pause and ask your HR department or insurance provider if what is being offered to you is allowed.
Third, report it. While benefits fraud is easy to view as a faceless, victimless crime, it affects everyone — including your employer, your colleagues and your family. If you suspect that a coworker or health or dental service provider is committing benefits fraud, you can report it anonymously via your insurance provider’s website or by visiting fraudisfraud.ca.
