Fighting benefits fraud

Insurance fraud prevention requires joint approach between plan sponsor, insurer
By Diane Bezdikian
|Canadian HR Reporter|Last Updated: 09/06/2016

It’s estimated fraud costs Canadian life and health insurers hundreds of millions of dollars every year, according to the Canadian Life and Health Insurance Association. These costs also impact group insurance plan sponsors.

Two examples of group benefits frauds recently detected by Great-West Life highlight the nature of fraudulent activity faced by the insurance industry.

One case began with a simple massage therapy claim that the insurer’s fraud systems flagged due to high claim volume within a family. A full review of the plan member’s claim history turned up a false hospital receipt, among other inconsistencies.