Did you know that benefits fraud costs Canadian employers and insurers hundreds of millions of dollars annually?[1] Over the years fraud trends have evolved and become more complex with the use of sophisticated schemes and technology. It is crucial for organizations to stay vigilant and informed about the latest scams and emerging cybersecurity threats they may face.

Nowadays, cyber-enabled fraud is becoming more prevalent. It includes activities like email phishing, identity theft, and payment fraud, leading to significant financial losses for organizations.[2] Implementing fraud detection and prevention programs play a vital role in mitigating risks to benefits plans. Effective fraud prevention strategies require a collaborative approach between employers and group insurance providers.

Sun Life’s Fraud risk management team helps protect the financial integrity of employee health benefit plans by using advanced technology to detect unusual or suspicious claiming patterns. This ensures coverage is used appropriately for legitimate health needs. If we suspect fraud or collusion from a provider, we use our Service Provider Delisting program. Delisting ensures that we stop processing claims from the identified provider. As of 2024, Sun Life has delisted over 5,000 suspicious entities. This commitment has resulted in saving employers over $300 million since 2014.[3] By reducing fraudulent and abusive claiming, we help employers control rising healthcare costs while still enabling them to provide comprehensive coverage to employees.

Employers also play a proactive role in reducing the risk. Through cultivating a culture of awareness and vigilance throughout all levels of their organization, they can empower employees to recognize and report any suspected fraud.

To reduce the risk of benefits fraud, here are actions employees can take:[4]

· keep passwords confidential,

· use multi-factor authentication as it provides layers of security that verify identity,

· verify claim submission for accuracy,

· check claims receipts, and

· report any suspicious activity to employers or their benefits carrier.

Sun Life provides helpful resources employers can share with their employees. By better understanding and recognizing fraud and abuse, employers and employees can help reduce the risk of benefits fraud and keep plans affordable. To learn more about group benefits fraud and how to protect your group benefits plan, visit our Fraud Risk Management page.

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[1] Canada Life and Health Insurance Association website: www.clhia.ca
[2] Fraud Prevention Podcast Episode 2
[3] Our estimated annualized claims reduction impact is calculated based on paid claims before and after the profiling start date.
[4] Recognizing fraud and abuse, Sun Life 2025.