How to detect fraud
As an Alberta Blue Cross® plan member, you have a responsibility to safeguard your benefit plan and report any suspicious or fraudulent activity.
Here are some steps you can take.
Watch your accounts for any suspicious activity, such as claims you did not submit or transactions you did not make.
When you receive a receipt or invoice from a provider, ensure that it is filled out with all the correct information, including date, claimant name, provider name and benefit type.
Before visiting a health service provider, ensure that they are licensed with a governing professional college or association recognized by Alberta Blue Cross® and that they are not one of our delisted providers.
As a plan administrator, you may be in a position to notice when someone is committing benefits fraud or abuse.
Here are some signs to watch out for.
An employee living beyond their means.
Anyone who seems to be living a lifestyle beyond their means may be receiving funds from another source.
An employee who encourages others to see their medical provider.
While referring someone to a professional is not inherently suspicious, if an employee brings it up unprovoked or is particularly insistent that you see their medical provider, it may indicate that they are receiving a kickback.
An employee who indicates they are abusing their benefit plan.
Not everyone is aware that their actions may constitute benefits fraud or abuse. An employee who talks about how they are submitting false claims or receiving free products or services from a health care provider is most likely abusing or defrauding their plan.
While not every action above indicates that benefits fraud or abuse is occurring, it’s important to stay vigilant and watch for suspicious behaviour. Remember, if a deal is too good to be true, it generally is.