Fraud prevention

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You play an active role in protecting your benefit plan from fraud and plan abuse. Check out how you play a role in the detection and prevention of health care fraud and benefit plan abuse. Take fraud and plan abuse seriously!

The overwhelming majority of Alberta Blue Cross customers, health service providers and suppliers are honest and ethical in their dealings with Alberta Blue Cross. As a result, health care fraud and benefit plan abuse is rare. Unfortunately, however, it sometimes does occur.

Fraud and plan abuse cause benefit plan costs to rise, which means higher plan premiums for consumers—for Albertans like you. Every dollar of fraud or plan abuse must ultimately be paid by individual plan participants and plan sponsors.

Zero tolerance

At Alberta Blue Cross, we believe every dollar of health care fraud and plan abuse is a dollar too much. For this reason, Alberta Blue Cross has a policy of zero tolerance towards any fraudulent abuse of the benefit plans we administer on behalf of our customers. We actively investigate and pursue all suspected fraudulent activities, and have extensive measures in place to detect and combat fraud. These measures include monitoring of claim patterns, auditing to ensure compliance with plan contracts and agreements, pursuing civil and criminal prosecution where evidence indicates fraudulent activity has occurred, and restitution where warranted. Every year, Alberta Blue Cross recovers thousands of dollars through auditing and fraud control measures.

You are the first line of defense

Consumers and health care service providers are often the first line of defense in battling health care fraud. Plan participants, plan sponsors and health care service providers all play an important role in helping to combat suspected fraud and plan abuse. Protect yourself against health care fraud by being a smart consumer of health care services. Do your part to help reduce health care fraud—and you’ll be doing your part to help protect the viability of your Alberta Blue Cross benefit plan.

If you suspect any potential fraud or plan abuse, or any improprieties which may include fraudulent activity, please contact the Alberta Blue Cross fraud hotline toll-free at 1-866-441-8477 or through the Alberta Blue Cross Fraud, Privacy and Ethics Reporting service. All information will be kept strictly confidential, including your identity. Suspicions of fraudulent activity may also be reported anonymously.