Benefits fraud is a top concern among plan sponsors and insurance carriers, as it makes the cost of providing benefits plans more expensive, leading to higher insurance premiums.
At Benefits Canada’s 2019 Benefits and Pension Summit in Toronto on April 17, Shelley Frohlich, director of fraud risk management in Sun Life Financial Inc.’s group benefits division, will be offering an insurer’s perspective on how data analytics, proactive measures and industry partnership can help fight fraud.
“The group insurance mandate really is to protect the integrity of benefits plans, by helping reduce the financial reputational risk to an organization or its plan sponsors,” says Frohlich. “And this is done in a number of ways: ensuring there are appropriate and effective detection and prevention controls in place; investing in leading-edge technology; employing a well-trained investigative services unit with diverse skills and background; collaboration with key stakeholders; and raising awareness.”
A key prevention tactic is to have teams dedicated to identifying irregular claiming patterns and outliers that would warrant further investigation and may reveal collusion-type schemes where two or more parties or individuals are involved in the submission of false claims, says Frohlich. This means “participating in a criminal offense, such as fraud on the benefits plan.”
Sometimes, though, a plan member doesn’t even realize they’re participating in this type of criminal scheme and are unaware of the potential consequences, she says.
What are the consequences? “They could lose their employment,” says Frohlich. “We will turn over results [to the employer] when we have evidence to support fraudulent claims submissions and plan sponsors typically take the approach to terminate their employees from their employment.”
In the session, Frohlich will be joined by Terisa Ducharme, associate director of pension, benefits and human resources at York University, who will share an employer’s experience over the last five years.
To attend this session and other benefits and DC pension topics, register for the 2019 Benefits and Pension Summit here.