iAtoday

Group insurance fraud takes many forms, and it’s essential that plan sponsors and plan members remain vigilant and proactive in preventing it.

Here are the five most common types of group insurance fraud:

• Forging a receipt: Submitting a receipt for a higher amount than the service received.
• Claiming a service that was never received.
• Submitting a claim on behalf of another person: Submitting a claim on behalf of a dependent when the service has been received by another person who is not insured or whose covered maximum for the year has been reached.
• Colluding with a provider: A provider offers to submit a false claim in exchange for a portion of the payment or some other benefit.
• Provider fraud: A provider submits a false claim without the plan member’s knowledge for a service never provided and pockets the money directly from the insurer.

Our commitment

As a responsible company managing group insurance plans, we do everything in our power to minimize the consequences of fraud.

To do so, we act at different levels:

• Random claim verification: Any claim may be subject to verification.
• Use of advanced data analysis technologies to detect fraudulent behaviour.
• Regular inspections of providers and associations to ensure compliance with best service provision practices.
• Collaboration with the Canadian Life and Health Insurance Association (CLHIA) on numerous fraud prevention and enforcement initiatives.

A collective effort

Combatting group insurance fraud is a collective responsibility that requires everyone’s cooperation. Sponsors and members alike can help prevent it and protect the integrity of their plans.

Communications to plan sponsors and plan members:

• Communiqué to group insurance plan sponsors (March 24 – French version)
• Email to plan members (French version)

If you have any questions, please feel free to contact your iA Financial Group Account Executive.