We are always on the lookout for benefits fraud and abuse. Through a combination of advanced analytics, machine learning and a dedicated audit and investigation team, we work hard to stop fraud in its tracks before it can threaten the sustainability of your plan.
Fraud prevention is a constantly evolving system. When we catch someone committing benefits fraud or abuse, we don’t just stop the crime—we learn from it. We take the lessons from every case and build them into our robust and comprehensive fraud prevention plan.
Here are some of the recent cases of benefits fraud and abuse we’ve dealt with.
Mar 15, 2023
A provider dispensed ineligible products...
Incorrect procedure codes
Mar 8, 2023
A provider submitted claims for ineligible services...
Accessing employer information
Mar 1, 2023
A member obtained access to her employer’s group plan administration portal...
Coupled in crime
Feb 24, 2023
2 members—a couple—enrolled in group benefit plans...
Submitting false claims
Dec 30, 2020
A plan member enrolled in a group benefit plan...
Services not received
Dec 29, 2020
Two individual plan members enrolled in benefit plans with us...
The information on this page is based on data provided by our private book of business.