Insurance FraudWe’re committed to protecting your benefits from insurance fraud and abuse. Insurance fraud can happen in many different forms, from backdating a disability claim to submitting a false medical or dental claim. These and other forms of fraud raise the costs of benefits plans to employers.What is insurance fraud?Health insurance fraud is described as an intentional act of deceiving, concealing, or misrepresenting information that results in health care benefits being paid to an individual or group. Fraud can be committed by both the employee and a provider.Who commits insurance fraud?Anyone who has access to your insurance information can submit fraudulent claims—for example, you or your family members, or doctors, dentists or other service providers.What are the penalties?Confirmed cases of fraud are documented, and can be reported to your employer if necessary. This can result in disciplinary or other action.Fraud is a crime, and cases may also be reported to the police. Convictions for fraud can carry penalties ranging from restitution, where the person must pay back the funds plus legal fees and interest, to a criminal record and even jail time.How does insurance fraud affect me?Insurance fraud is often referred to as a hidden crime, but the costs are quite visible. Employers and Employees become the victims of insurance fraud through increasing premiums.What can you do?You can help prevent fraud by being a responsible consumer. Be aware of who you give your benefits coverage information to, and what you sign. You are responsible for the accuracy of any claims submitted on your behalf, and of any information you provide to support your claim.Be part of the solution:

• Do not provide blank signed claim forms to a service provider to submit the claim later. These can be used to submit fraudulent claims in your name.
• Be sure the claims you submit are for supplies and services that are medically necessary.
• Be wary of aggressive marketing programs—for example, where a provider offers you a gift for becoming a client or for soliciting other employees to become clients, or offers to refer you to another provider for a prescription.
• Watch for providers who charge 2 different fees—a higher fee for clients with insurance and a lower fee for those who do not have insurance.
• Shop around - Costs can vary significantly among suppliers and providers. While most of the cost may be covered by your plan, higher prices can mean higher overall costs for your plan and may lead to reduced benefits.

Please report suspicious situations to the Co-operators at 1 800 667-8164 http://www.cooperators.ca/en/Group/group-benefits.aspx: