2019 saw headline news related to workplace benefits fraud. As year-end nears working Canadians may rush to use-up benefits, and some may intentionally submit false or misleading information to insurance providers in the process.
Many Canadians don’t understand that health and dental benefits fraud is a crime.
According to a 2018 survey conducted by Environics Research for the Canadian Life Health Insurance Association (CLHIA), 75 per cent of insured Canadians think that the main consequence of benefits fraud is having to pay higher premiums or reimburse claim payments.
In fact, health and dental benefits fraud is a real crime with real consequences that can include loss or reduction of benefits, loss of employment, a criminal record, fines and jail time, cautions CLHIA.
The CLHIA, which represents 99 per cent of Canada’s life and health-insurance companies, is raising consumer awareness of health and dental benefits fraud through its Fraud=Fraud campaign.
Benefits fraud occurs when you intentionally submit false or misleading information to your insurance provider for the purpose of financial gain, and it can take many forms. Examples include (but are not limited to) — billing for health or dental services that were never received; submitting the same claim to multiple insurers to double your reimbursement; and letting someone not covered by your plan use your benefits.
Benefits fraud can be committed by health or dental service providers, plan members or both.
You can become involved in benefits fraud without even knowing it. For example, a health or dental care provider could ask you to sign a blank claim form which they can use dishonestly later without your knowledge. If they do, you are involved in benefits fraud.
You can protect yourself from a benefits fraud by learning how to use your benefits appropriately. Learning how to recognise benefits fraud can help you refuse it and report it.
If you suspect your health or dental service provider, coworkers, or others you know are encouraging you to submit a fraudulent claim, or something just doesn’t feel right, report it to your employer or insurance provider immediately. Report fraud anonymously here.