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5 tips for preventing benefits abuse and claims fraud

benefitsfraud

Benefits fraud comes in several forms, including fraudulent claims for health services. In most cases, these schemes include claims for services not actually rendered, providers performing services outside of their practice or even unlicensed individuals performing insurable services.

The best thing any plan sponsor can do to mitigate health benefits claims abuse is to take active steps to prevent it from occurring. Here is our list of 5 tips for preventing benefits fraud:

  1. Prevention
    It is better to prevent fraud from happening in the first place. Ensure that you have strategies in place to help prevent fraud from occurring.
  2. Deterrence
    Similar to prevention, anything that can be done to deter fraudsters from acting is a good thing. The penalties involved should be made clear. Where possible, making an example out of employees who defraud your plan will help deter others from even thinking about it.
  3. Detection
    Make sure you are vigilant about identifying fraud patterns, and look for red flags in various areas.
  4. Investigation
    Support the investigations launched by your benefits insurer. And don’t shy away from playing an active role when the tips come from staff.
  5. Recovery & Remediation
    Think carefully about recovery strategies. These also act as deterrents for others contemplating getting involved in fraudulent schemes.

 

Plan sponsors should do their utmost to create an anti-fraud culture within the organization. Have clear policies and guidelines on appropriate utilization of benefits, and take steps to raise employee awareness about the cost of the problem. Explain how fraud can negatively affect plan members, their benefits and, possibly, their employment status. If you have concerns about your plan design or risk exposure to healthcare fraud, be sure to contact ICBA Benefit Services today at 604-298-7752 or info@icbabenefits.ca.

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