Keyword: Benefits fraud

27 results found

The Toronto Transit Commission has settled a 2016 lawsuit against its insurer for the alleged failure to detect a benefits fraud scheme involving orthotics store Healthy Fit Inc. To date, 10 people — nine former TTC employees and Healthy Fit owner Adam Smith — have been convicted in relation to the scheme. More than 250 TTC employees resigned or […]

  • By: Staff
  • November 15, 2019 December 3, 2020
  • 09:15
Toronto hospital dismisses 150 staff for alleged benefits fraud

About 150 employees at Baycrest Health Sciences have been dismissed for benefits fraud. Last year, in the course of establishing an approved provider network for its employee benefits, the Toronto geriatric hospital said concerns were raised about some of the extended health-care claims employees were making under the benefits plan. “As a result, we retained a third […]

  • By: Staff
  • July 11, 2019 November 12, 2020
  • 10:00
Awareness key in benefits fraud detection and prevention

As benefits fraud schemes become more sophisticated, group insurers must continuously evolve their strategies to keep up to date, according to Shelley Frohlich, director of fraud risk management at Sun Life Financial Inc. A group insurer’s role is to help protect the integrity of the benefits plan by reducing the financial and reputational risks to an […]

Since recreational cannabis was legalized across Canada six months ago, related workplace problems have mainly been notable by their absence. “It’s been a surprising lack of significant issues arising in the workplace,” said Angelo Tsebelis, president at Starseed Medicinal Inc., during a panel at Benefits Canada’s 2019 Benefits and Pension Summit in Toronto on Wednesday. This […]

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 […]

Head to head: Who’s responsible for detecting benefits fraud?

With benefits fraud a growing issue for plan sponsors, the recent spate of fraudulent activities at large organizations has prompted the question of who’s responsible for identifying benefits fraud in the first place. Is it insurers, plan sponsors or plan members? Mark Russell, director of investigative services at the Toronto Transit Commission: Five years ago, […]

Green Shield launches fraud detection, prevention strategy based on AI

Green Shield Canada is partnering with HBM+’s health benefits management solutions provider division to introduce an artificial intelligence-based fraud detection strategy. Under the new Claim Watch banner, the new platform finds and compiles data, identifying patterns to unearth suspicious activity.  “We’re very proud of what GSC and HBM+ do in the fraud detection and prevention […]

  • By: Staff
  • March 8, 2019 September 13, 2019
  • 08:20
CLHIA’s CEO lays out some of the big industry topics for 2019

As 2018 draws to a close, and the benefits and pension industry looks ahead, what’s next for the year’s biggest topics? Stephen Frank, president and chief executive officer of the Canadian Life and Health Insurance Association, is expecting a shift from Canadian and global regulators in the way they govern how customers are treated: an […]

  • By: Ryan Murphy
  • December 21, 2018 September 13, 2019
  • 08:56
Using data analytics, AI technology to curb benefits fraud

The numbers in the Toronto Transit Commission’s benefits fraud investigation are staggering — 725 total cases, 220 dismissals, 120 arbitrations, 10 employees charged and more than $3 million in exposure. “All this stuff is still ongoing. The insurance company hasn’t cut us a cheque yet,” Mark Russell, staff sergeant, investigative services at the TTC, told attendees at […]

Have your say: Are incentives for orthotics claims a concern for benefits plans?

A red flag goes up for Dan Mead whenever an orthotics customer comes into his clinic asking about getting free shoes. “Clearly, we do see the issue, because patients do come in to our office, just speaking anecdotally . . . and you can tell what they’re looking for,” says Mead, a certified prosthetist and […]