Benefits Fraud Prevention
While ASEBP strives to protect you all year-round, benefits fraud continues to impact all of us and has serious consequences. The best way to prevent benefits fraud and protect your benefit plan is to report suspicious activities. If you notice anything suspicious in your claims history or witness or know of any benefit plan fraud, report it now:
- Email: tips@asebp.ca
- Call: 1-844-827-TIPS (827-8477)
What is Benefits Fraud?
Benefits fraud refers to intentional abuse, misuse or overuse of the benefit plan for personal gain. This is unlawful and affects everyone. It has lasting impacts, including higher premiums, suspension of benefit coverage or worse. Benefits fraud examples:
- Transferring coverage between covered family members (e.g., claiming a service under a dependant's benefit coverage when the service was for you)
- Accepting incentives or gifts from providers in exchange for submitting claims (e.g., getting a free pair of shoes or a purse with foot orthotics)
- Claiming benefits that are not covered by the plan as an eligible benefit (e.g., receiving a spa treatment and claiming it as a therapeutic massage)
- Providers claiming for products or services that were not provided
- Misrepresentation of conditions in a disability claim
Our Approach
ASEBP's Approach
Using robust systems, large amounts of data can be analyzed at any given time. This information is routinely reviewed to ensure claims accuracy, and ASEBP has implemented measures to detect unusual claiming patterns that could be related to benefits fraud.
The Benefit Assurance team monitors and analyzes information, conducts audits and reviews on claims, and determines the most suitable action against cases of fraud.
Providers Tool and Ineligible Providers Tool
Service Providers Tool
When using the Service Providers tool, service providers shown are in Alberta and only providers who have had claims processed by ASEBP in the last 6 months are visible. This feature is for informational purposes only as the ASEBP covered members provider recommendations are populated in the Service Provider tool.
Delisted Providers Tool
An ineligible providers tool is available on My ASEBP/the Mobile App to help covered members make informed decisions when seeking providers within Alberta. The list contains providers ASEBP will not accept claims from due to non-compliance with claiming standards – ASEBP will not reimburse for services or products provided by them.
Top 3 Tips: Fraud, or Not?
- Choose health providers carefully by checking ASEBP’s delisted providers list (log into My ASEBP, select Delisted or Ineligible Providers tab)
- Double check benefits provider details and credentials
- When in doubt, contact an ASEBP benefit specialist:
- Toll-free: 1-877-431-4786
- Appointment: Book a time to speak meeting with a benefit specialist
- Email: benefits@asebp.ca
How to Keep your Benefits Safe
- Do not accept incentives
Cash, gift cards, or material items from service providers are benefits fraud flags. Only purchase products or services that are medically necessary. - Never sign blank claim forms
Only sign claim forms once you have confirmed they are complete and accurate. - Always review receipt information
When claims are direct billed, ask for a printed copy of your Explanation of Benefits. This will provide you with your claim details. If you notice any discrepancies, be sure to have your provider contact the Provider Services department to correct the claims information. - Personal information
Only share ASEBP ID and personal information with your providers and ASEBP benefit specialists. - Review claims history
Regularly check your claims online on My ASEBP or on the Mobile App to make sure claim details are correct.
Covered members, and members of the public, have access to anonymous reporting tools to help report fraud, including a confidential hotline and email.
As a trusted partner, ASEBP’s goal is to ensure the continued viability of the Plan to continue to support your, and your family’s, health needs.
For more information about benefits fraud, visit the Canadian Life and Health Insurance Association.