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Silverberg Group - Bringing Your Employee Benefits into Focus

Claims Fraud

Each year group benefit plans lose large sums of money to benefits fraud which ultimately drives up plan costs. What employers may not be aware of is the extent to which fraudulent conduct on the part of patients and healthcare providers contribute to escalating premium levels.

Fraud is obvious only after it is discovered. As a result, statistics are best guesses about the degree of fraud that occurs. The Canadian Health Care Anti-Fraud Association estimates that 2% to 10% of all healthcare dollars spent in North America are spent fraudulently. With healthcare spending in Canada estimated to have surpassed $160 billion in 2007, this suggests that the amount lost to healthcare related fraud falls between $3.2 billion and $16 billion dollars annually. This is a staggering sum and one that is passed on to employers and employees in the form of higher benefit premiums.

Fraud committed by employees includes:

Fraud committed by healthcare providers includes:

All insurance carriers have measures in place to assist with detecting and preventing fraud such as:

Below are several ways of assisting in preventing fraud:

If you have questions regarding claims fraud and your plan, please feel free to contact us.

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