Do you know how to protect yourself from benefits fraud?
What is benefits fraud?
Benefits fraud is the intentional abuse, misuse, or overuse of the benefit plan for personal gain. It has lasting impacts that affect everyone, including increased premiums and reduced benefits, which may compromise the integrity of the benefit plan.
As your health and wellness benefits provider, ASEBP routinely reviews claims for accuracy and has implemented measures that aid in the prevention and detection of benefits fraud and abuse to ensure the financial sustainability of the plan. Identifying and preventing benefits fraud is a shared responsibility. Working together to help prevent benefits fraud protects you, your family, and ASEBP.
How to spot benefits fraud
Incentives or gifts like cash, gift cards, or material items offered by service providers can be a warning sign of benefits fraud.
Here are a few examples of benefits fraud to watch out for:
- Service providers transferring coverage between covered family members (e.g., claiming a service under a dependant’s benefit coverage when the service was for you)
- Service providers claiming benefits that are not covered by the plan as an eligible benefit (e.g., an ineligible spa treatment being claimed as a therapeutic massage)
- Service providers claiming products or services that were not actually provided.
Three tips for preventing benefits fraud
Here are three ways you can help:
- Regularly review your claims history for unusual or suspicious claims.
- Choose your service providers carefully. Stay informed and know what to look for when choosing a service provider.
- Check ASEBP’s list of Ineligible Providers found on My ASEBP.
- Check service provider details and credentials. For example, ASEBP requires massage therapy to be provided by registered massage therapists with a minimum of 2,200 hours of massage therapy training.
- When in doubt, call an ASEBP benefit specialist.
- Report unusual or suspicious service provider behaviour or claims.
- Send an email to tips@asebp.ca, or call our anonymous hotline toll-free at 1-844-827-TIPS (827-8477) and leave out your personal information.
You can help protect your benefits and ensure ASEBP is able to continue serving as a trusted partner in covered members’ lifelong health and wellness journeys.
For more information, visit Benefits Fraud Prevention.