Life and health insurers to tackle benefits fraud through joint investigations

(Toronto, March 1, 2023) – Canada’s life and health insurers are now working together to conduct joint investigations into health service providers that are suspected of fraudulent activities.
All life and health insurers take anti-fraud management seriously. The industry continues to make significant investments in technology, skilled staff and education programs to mitigate fraud. Working through the Canadian Life and Health Insurance Association (CLHIA), participating insurers will collaborate on joint investigations into suspected benefits fraud schemes that impact multiple insurers.

“Having insurers work together on provider fraud investigations is a huge step in our industry’s efforts to further reduce suspected benefits fraud,” said Stephen Frank, President and CEO of the CLHIA. “Together we can better identify irregularities and dedicate resources to go after the small number of providers who are deliberately abusing health benefit plans.”

Today’s announcement builds on last year’s launch of a CLHIA-supported industry program that uses advanced artificial intelligence to identify fraudulent activity across a vast industry pool of anonymized claims data. Both initiatives are part of an industry strategy to leverage the knowledge, expertise, and resources of life and health insurers to reduce the time it takes to act on those who are exploiting workplace health benefit plans.

Insurers paid out nearly $41 billion in supplementary health claims in 2021. It is estimated that employers and insurers lose millions of dollars each year to benefits fraud. Benefits fraud is a crime that effects insurers, employers and employees and puts the sustainability of workplace benefit plans at risk.