Fraud prevention

Employee Benefits Tips and Tricks: Canada Larger Client Considerations
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Transcript

Hi, Alan freezin, here certified Employee Benefit Specialist. Fraud on health plans is a huge deal. And it takes many different forms. Basically, it could be doctoring receipts, it could be working with the provider to bill for more expensive services that haven't been done than what was done or billing for services that hadn't been done at all right. Those are all different options that could occur. So there's many, many different ways that it could occur.

Sometimes it's the plant administrator working together with the plan members, sometimes the planet members who don't speak English very well are manipulated by the administrator to manipulate the system and get dollars out of it. So all of the insurers out there are very diligent about monitoring, unusual claiming patterns. Sometimes they're just unusual claiming patterns, but sometimes they're fraud involved. And if you run across a situation it concerns you speak to your plant advisor about them about that situation and have them intervene, have them have the discussions with the insurer about that situation. The why it's important, of course, is because any of that fraud cost money for all of us who are participating in those programs, and is significant and can be like 15% of the cost of the of the program of the health program is related to fraudulent activities. Well, why should I pay 15% more for somebody else who's going to steal cheat lie in order to make those claims?

Why should you so I encourage you to work with your plant advisor to work with your company, the insurance company in order to keep the value as best as you possibly can on your programs. Of course, you want the programs to pay for the claims that are going to contribute to people's health to your

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