The YXE Benefits is the simple, stable, smart choice for Saskatoon businesses; combining accessibility, flexibility and the stability of pooled benefits. Saskatoon companies choose the group plan because it offers unsurpassed value & outstanding customer service. The Chambers plan group benefits are for Chamber members. In our latest post, we discuss benefits fraud and share important information from Fraud is Fraud..
Benefits Fraud Is A Crime
Do you think using your dental or health benefits dishonestly is no big deal?
Whether it’s just a small, one-time thing, or a larger, ongoing scheme, benefits fraud of any kind is still considered fraud, and it’s a real crime with real consequences.
Benefit Fraud Is Stealing
You commit benefits fraud when you intentionally submit false or misleading information about the health or dental treatments you receive under your employer’s benefits plan. You may do it because you need some extra money, or you want more treatments or services than your employee benefit plan covers. Either way, you’re committing a real crime and must be prepared to face the real consequences.
WHAT DOES HEALTH AND DENTAL BENEFITS FRAUD LOOK LIKE?
People you may not expect, like health and dental service providers, friends, family members, and colleagues, could all lead you to commit benefits fraud. It is possible to become involved in it because it was suggested by someone you trust. It’s important to learn what it looks like so you can help prevent it.
Learn how to recognize the signs of benefits fraud..here are some examples below.
Letting a friend use your health or dental benefits because they exceeded their own coverage.
Using your benefits to purchase non-prescription sunglasses and submitting the claim as prescription eyeglasses
Increasing the amount of your claim to cover any portion of the cost not covered by your insurance.
Claiming a treatment or service under a dependent’s benefit coverage when you used the treatment or service yourself.
Claiming prescription drugs on behalf of others who are not covered under your plan.
Submitting a full claim for the same service to multiple insurers to double your reimbursement.
Buying trip cancellation insurance after you find out you have to have surgery and cannot go on a scheduled trip
What are the consequences of health and dental benefits fraud?
The consequences of benefits fraud can include loss or reduction of your benefits, loss of employment, a criminal record, fines and jail time.
HOW TO RECOGNIZE HEALTH AND DENTAL BENEFITS FRAUD
Benefits fraud is not always easy to spot, especially when a trusted co-worker, friend, family member or health or dental service provider suggests it. Look for these warning signs and alert your insurer if they occur:
- Feeling pressured by your health or dental service provider to get unnecessary products or procedures
- Being encouraged to claim products or services that are not eligible as a benefit under your plan as different products or services that are eligible
- Health or dental service providers who seem more concerned with the details of your insurance coverage than providing the right product or service
- Feeling encouraged to include incorrect or misleading information on a claim
- Being asked to sign a blank claim form (often completed later with misleading information)
- Health or dental service providers who use your plan membership information to charge for products and services you never received
- Being offered cash or other incentives in exchange for your policy information
Contact us today for a quote…. find out if you can benefit!