Accessing employer information

A member obtained access to her employer’s group plan administration portal, created, or altered existing member services accounts for other employees and submitted fraudulent claims.

Approach

The group was identified by our analytics team. We contacted the providers and confirmed that the services claimed did not take place. In addition, we contacted the members who had claims submitted under their coverage numbers, and they confirmed that they did not receive the services.

Results

The case was reported to the plan sponsor and the member’s employment was terminated. Evidence was collected and presented to law enforcement. The member was charged and subsequently pled guilty. The employer conducted their own investigation and identified instances where the member defrauded the company.

Identified by analytics team

Employment terminated

Investigation with law enforcement

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Member plead guilty

Conclusion

The member has plead guilty to the charges. Lessons learned for the public: this highlights the importance of keeping your Alberta Blue Cross® login information secure and to never share the information with anyone. It also shows the consequences to members who knowingly submit false claims and documentation—loss of employment as well as criminal charges.

The information on this page is based on data provided by our private book of business.