Benefits fraud is a real crime with real consequences
News ReleaseRelease Date: 03/04/2019 Staff Reference: Kevin Dorse
(Toronto, March 4, 2019) – As part of Fraud Prevention Month this March, the life and health insurance industry is supporting Canadians in the fight against workplace benefits fraud. The Canadian Life and Health Insurance Association (CLHIA) is raising consumer education and awareness around health and dental benefits fraud through the Fraud=Fraud campaign.
Each year, insurance companies lose hundreds of millions of dollars to fraudulent health and dental claims. This fraud costs all Canadians through higher premiums, but can also result in serious criminal consequences. The CLHIA’s goal during Fraud Prevention Month is to help Canadians recognize fraud, understand how to avoid becoming involved in fraudulent activities, and increase awareness that fraud is a crime with real consequences. Resources to identify and report benefits fraud are available at the Fraud=Fraud website at fraudisfraud.ca.
"Benefits fraud is becoming more widespread, in part because, as we’ve found in our research, many don't understand that it is a crime," notes Stephen Frank, President and CEO of the CLHIA. "Most people think, if you are caught, you would just repay the money. In fact, the consequences are bigger than that and can include the loss of your job and in some cases, ending up with a criminal record and jail time."
Benefits fraud occurs when an individual intentionally submits false or misleading information about the health or dental benefits they received under their employer's benefit plan. According to a survey conducted by Environics Research for the CLHIA, 75 per cent of Canadians incorrectly believe that the only punishment for benefits fraud is having to pay higher premiums, or be forced to reimburse claim payments.
Although there have been some cases where individuals did not understand that they were engaging in fraud, the industry is increasingly seeing evidence of organized crime, or unscrupulous service providers getting involved and reassuring their victims that what they are doing is normal or that they are entitled to the money.
"We are seeing more of these sophisticated schemes. In cases where we identify these larger frauds, companies may have to lay off large numbers of staff in response. This can have a huge negative impact on employers. That is one reason why we believe this Fraud=Fraud campaign is both timely and necessary," added Mr. Frank.
About the CLHIA
The CLHIA is a voluntary association whose member companies account for 99 per cent of Canada's life and health insurance business. The industry provides a wide range of financial security products such as life insurance, annuities (including RRSPs, RRIFs and pensions) and supplementary health insurance to more than 29 million Canadians. It also holds over $860 billion in assets in Canada and employs more than 155,000 Canadians.
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