Association intent on raising awareness to help more Canadians recognize crime and its consequences
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Health and dental benefits fraud however small hurts everyday people and must be stopped, according to the Canadian Life and Health Insurance Association (CLHIA).
The industry is stepping up its efforts to fight this criminal behaviour through its Fraud=Fraud campaign, which aims to raise the level of consumer education and awareness around the issue.
Its goals are to help Canadians recognize fraud, understand how to avoid becoming involved in fraudulent activities, and increase awareness that fraud is a crime and can have severe consequences.
Benefit fraud occurs when an individual intentionally submits false or misleading information about the health or dental benefits they received under their employer's benefit plan.
According to a March 2018 survey conducted by Environics Research, 75% of Canadians incorrectly believe that the only punishment for benefits fraud is having to pay higher premiums, or be forced to reimburse claim payments.
Shannon DeLenardo, director, anti-fraud and electronic claims at CLHIA, said individual companies had seen an increase in fraudulent activity and had approached the organization about doing an industry-wide campaign.
She admitted she was surprised by the 75% figure but not that people generally don’t know the consequences of committing benefit fraud.
She said: “It hurts everyone. Regardless of how big it is, it has far reaching implications. If planned sponsors are constantly looking at ways to ensure that plans remain sustainable, any time people are being abusive or fraudulent, it has an impact on plan sustainability.
“It also forces plan sponsors to make some pretty challenging decisions as to whether they are going to cut benefits or whether they are going to implement larger co-pays or more premium on the employer side, so the implications can be far reaching.”
DeLenardo said people sometimes unknowingly and naively become involved in fraud and often don’t realise what they are doing amounts to criminal activity. She added that collusion between providers and plan members is especially hard to detect because each side is protecting each other.
“The long and short of it,” she said, “is if you are submitting claims with the intent of financial gain then you are committing fraud.”
DeLenardo said the key is education and getting the message out via the campaign and the association’s website, which has a facility where anyone who suspects they may be a victim of fraud or knows someone who is committing fraud can submit a report, anonymously, detailing what had happened.
