Insurers launch joint investigations to tackle benefits fraud

Investigations will be conducted through association

Insurers launch joint investigations to tackle benefits fraud

Life and health insurers in Canada have announced they will be working together to investigate health service providers that are suspected of fraudulent activities.

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.

“All life and health insurers take anti-fraud management seriously,” the CLHIA said in a press release. “The industry continues to make significant investments in technology, skilled staff and education programs to mitigate fraud.”

Industry-wide effort to mitigate fraud

The joint investigations are part of an industry-wide effort to reduce the time it takes to act on those exploiting workplace health benefit plans, building on last year’s launch of a CLHIA-supported industry program which utilises advanced artificial intelligence to identify fraudulent activity across the industry’s massive pool of anonymized claims data.

Both initiatives leverage the knowledge, expertise, and resources of life and health insurers to mitigate fraud by reducing the time it takes to act on those who are exploiting workplace health benefit plans, the CLHIA said.

Insurers paid out nearly $41 billion in supplementary health claims in 2021, according to the CLHIA. Employers and insurers are also estimated to lose millions of dollars to benefits fraud each year, which places the sustainability of workplace benefit plans at risk.

“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.”

Last month, Frank joined The Empire Life Insurance Company president and CEO Mark Sylvia at an advisor webinar to discuss key industry trends emerging in the group benefits space this year.

“We paid out $30.4 billion in health, drug and dental care claims in 2021, up 14% over 2020,” said Frank at the webinar. “Even in the heart of the pandemic when everything had ground to a halt, our business was meeting our promises at a level never seen before in history. This shows the resilience and strength of the industry and the important role we play for so many.”

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