Case of the Quarter
Release Date: 07/11/2025 Staff Reference: Richelle Feddema
On March 1, 2023, CLHIA announced that Canada’s life and health insurers are working together to conduct joint investigations into health service providers that are suspected of fraudulent activities. Since then, numerous investigations have been conducted. Check out our Case of the Quarter which highlights a case that has recently been closed.
The CLHIA, and the Canadian insurers CLHIA represents, jointly investigate providers suspected of fraudulent activities.
July 4, 2025
Falsified claim documents result in outcomes* against a practitioner
The CLHIA supported a joint investigation of a massage therapist practicing in Alberta suspected of submitting false claims. Claiming anomalies were identified by individual insurer analytics and industry pooled data. By leveraging investigative resources and sharing de-identified claiming data, the insurers were able to obtain evidence that resulted in outcomes being taken against the practitioner.
The practice of massage therapy is not regulated in Alberta. In addition to the investigative process to protect plan sustainability from benefits fraud and abuse, the industry supports regulation of healthcare professionals for the protection of the public. The CLHIA, on behalf of its members, recently completed a submission to the Transitional Council for the College of Massage Therapists of Alberta, in support of the designation of those who offer massage therapy as a regulated health profession.
Learn more about what great work the insurance industry is doing to combat insurance fraud at www.fraudisfraud.ca.
March 27, 2025
False claims results in outcomes* against a clinic and multiple practitioners
CLHIA supported a joint investigation of a chiropractor practicing in Ontario suspected of submitting false claims. Claiming anomalies were identified by individual insurer analytics. By leveraging investigative tools and sharing de-identified claiming data the insurers were able to obtain evidence that resulted in outcomes being taken against a clinic and multiple practitioners the clinic employed. Benefits fraud and abuse impacts plan sustainability which Canadians rely on to maintain their health. Through this investigative process insurers strive to reduce the impacts of benefits fraud and abuse. Learn more about what great work the insurance industry is doing to combat insurance fraud at www.fraudisfraud.ca.
*Outcomes can include but are not limited to: delisting, college complaints, referrals to police.
