Prevent fraud and abuse in group insurance
Healthcare fraud and abuse costs you money. They can lead to higher premiums or a reduction in the coverage offered by your group insurance plan. Find out how to protect your plan.
Fraud or abuse?
Do you know the difference between fraud and abuse when it comes to group insurance? Here are some explanations.
Fraud
Fraud is the willful deception of group insurance for financial gain and is illegal.
Example of fraud:
An insured who makes a false claim.
A healthcare professional who lies about the care they have provided.
Abuse
Abuse is more difficult to pinpoint and often stems from a feeling of having a right to something rather than an intention to commit a crime.
It is generally not illegal, but remains highly unethical.
Example of abuse:
An insured who claims 6 pairs of compression stockings each year because his plan allows it and not because he really needs them.
Group Insurance Fraud - Really Not Worth It
Some people believe that group insurance fraud doesn't hurt anyone. In fact, it can have disastrous consequences ...
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How to prevent fraud and abuse of your group insurance?
Protect your personal information (eg: explanatory brochure and certificate number).
Never sign a blank form.
Make your complaint only after you have received and paid for a treatment or product.
Check the accuracy of all your receipts and group insurance statements. Did you receive the treatment or the product in question? Does the amount entered correspond to the amount paid?
Never agree to substitute treatments or products for others (eg, a receipt for physiotherapy treatment should not be issued for membership fees at a fitness center).
Make sure you understand the inclusions and exclusions of your group insurance plan.
Make sure the recommended care or products are medically necessary. If in doubt, ask for a second opinion.
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