Protecting Your Benefits Package From Fraud
Like everything of value, your benefits plan deserves to be protected, and that includes protection from fraud and abuse.
In the last couple of years, we have started to see an uptake on Benefits Fraud. We as humans like to believe that no one would commit these frauds, or we believe that it can’t hurt anyone, the insurance company has deep pockets. Most people submit claims in good faith. Unfortunately, a small but important percentage see benefits as a source of extra income. This includes Plan members who fabricate or falsify claims, Healthcare providers who submit fake claims—either on their own or in collusion with plan members.
Examples:
- Baycrest Hospital
- TTC Scandal
You play an important role in preventing fraud and abuse, here’s what you can do:
- Treat benefits fraud and abuse as a serious matter because It is a serious offence, offenders are stealing from your plan.
- Increase awareness, communicate with your employees. See that everyone receives a copy of their benefit booklet, so they are familiar with what their plan covers.
- Educate employees about their role in preventing fraud.
- Claim audits help prevent and detect benefits fraud and abuse.
See it.
Report it.
If you see suspicious claim activity or have questions about fraud and abuse, contact your Insurance Carrier (click here for contact information) or your Insurance Broker.
Talk to your Broker about plan design options that can help prevent fraud and abuse
Examples of things to consider:
- Dollar maximums on services such as medical supplies, orthotics, and massage therapy.
- Combined maximums to decrease overall risk.
- Co-pays to encourage employees to use their benefits wisely.
- A Healthcare Spending Account (HSA) to limit expenses but still offer flexibility.
Need help with your benefit package or to look at different options, contact us. We are more than happy to help you with Building a Better Benefits Plan than You Can Get Anywhere Else.