Keyword: benefits fraud

31 results found
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 […]

Have your say: Is benefits fraud a widespread problem?

With fraud prevention month underway, just how big of a problem is the issue for plan sponsors? “As an industry, we estimate that benefits fraud is costing . . . hundreds of millions in terms of the impact, so certainly not a small problem,” says Karen Voin, vice-president of group benefits and anti-fraud at the Canadian Life […]

Manager in Sudbury benefits fraud case ordered to pay $20M to former employer

A former Atlas Copco Canada Inc. manager sentenced to jail time for his part in a benefits kickback scheme now faces a $20-million bill from his former employer after the multinational industrial giant won a civil judgment against him. Dirk Plate, a one-time manager of Atlas Copco’s construction and mining division at its Canadian base in […]

Insurers stepping up fight against benefits fraud with analytics, big data

According to estimates from the Canadian Life and Health Insurance Association, benefits fraud results in the loss of two to 10 per cent of health-care dollars. In terms of preventative measures, Sun Life Financial estimates it saves plan sponsors about $20 million a year, while Great-West Life Assurance Co. suggests its strategies resulted in savings of […]

Top 10 health and benefits stories of 2017

One of the biggest topics in the health and benefits industry in 2017 was the federal government’s new 18-month parental leave option. Three stories on this issue topped the list, with news about benefits fraud, health benefits tax and medical marijuana also ranking. Benefits Canada rounds up your favourite health and benefits stories of 2017: Budget boosts parental […]

  • By: Staff
  • December 28, 2017 September 13, 2019
  • 08:35
A free purse with a benefits claim? How incentives can land providers, employees in trouble

While it might come as a surprise to some plan members, what may seem like a freebie or giveaway with the purchase of a medical device or service can actually count as benefits abuse. And in some case, offering incentives to customers will get a provider delisted by an insurance company. This week, for example, Shelley […]

  • By: Ryan Murphy
  • October 19, 2017 September 13, 2019
  • 10:37
Four tips to help employers curb benefits fraud

Group benefits are an invaluable tool most companies harness to attract and retain the best talent. For employees, they characterize a noble intent of care, compassion and protection. For employers, they can embody inherent risk. “Benefits are a form of compensation. And most benefit plans do not give employers any control of that compensation. Fraud […]