recognize benefits fraud

Support our campaign to fight benefits fraud

Insurance fraud is a growing concern. In total, private insurers paid out $34 billion in health claims in 2017. Estimates for the number of fraudulent claims range from 2% to 10%, meaning between $600 million and $3.4 billion is being stolen annually. It may seem like a victimless crime, but benefits fraud impacts everyone and affects the price of insurance premiums.

While most people are honest and claim legitimate expenses, we still need to be thorough in our review and adjudication of claims and ensure they meet the guidelines of the benefits plan. While our claims adjudicators are well trained to spot irregularities in claim activity and our audits provide additional protection, educating plan members is key in our efforts to fight benefits fraud.

The Co-operators has partnered with the Canadian Life and Health Insurance Association Inc. (CLHIA) to raise awareness and educate consumers about how to recognize benefits fraud.

Benefit fraud occurs when a person intentionally submits false information about medical or dental treatment to their benefits provider. The CLHIA has provided some great tips on how to recognize benefits fraud on their website. Our goal is to ensure that our plans continue to support the health and well-being of plan members and their families while remaining sustainable and cost effective.

Reporting fraud

Make plan sponsors aware that they, or their members, can report suspected fraud by contacting:

The Co-operators Group Client Service Centre

The CLHIA Healthcare Anti-fraud