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Benefits fraud


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What is fraud?

Have you ever been offered a “free” muscle roller when visiting your massage therapist? Or maybe you’ve thought about claiming your visit to the dentist under your spouse’s name since you already hit your dental maximum for the year. These aren’t innocent mistakes—they’re examples of benefits fraud and abuse, and they have serious impacts.

Benefits fraud happens when a person or group deliberately deceives the claims process for financial or personal gain. This can mean submitting a false claim, forging receipts, sharing benefits with others or misrepresenting services.

Benefits fraud can be committed by a plan member, the health care provider or through collusion. All acts of fraud are illegal, and they cost Canadians hundreds of millions of dollars each year. More than that, they threaten the sustainability of your benefit plan each day.

Committing benefits fraud costs more than just high premiums—it may cost a criminal record.



Private insurers pay approximately $36 billion in health claims each year.


The number of fraudulent claims is estimated to range from two to 10 per cent.


Benefits fraud costs between $720 million and $3.6 billion annually.

Increased premiums

Benefits fraud and abuse cost the Canadian health insurance industry up to $3.6 billion each year. This leads to increased costs that are passed on to employers and ultimately to employees or customers.

Inability to get insurance

Benefits fraud and abuse could lead to the creation of inaccurate or false records, which could affect a plan member’s ability to be insured through Alberta Blue Cross® or another benefits provider.

Reduction of benefits

When employers can no longer afford the additional costs brought on by benefits fraud and abuse, this results in the reduction or elimination of benefit plans.


Court—resulting in a criminal record.

Fines—repayment of false claims.

Jail—losing your passport and employability.

Many people think benefits fraud is a minor offence. In fact, 75 per cent of Canadians believe the biggest consequence of committing benefits fraud or abuse is having to reimburse the false claim payments or pay a higher premium.

In reality, the consequences are much more severe. You could lose your benefits completely, lose your job, receive heavy fines or even face jail time.

Committing benefits fraud costs more than just high premiums—it may cost a criminal record.