Prevent fraud

Minimize the costs to your plan

Benefits fraud can cost your company money— it may impact your budget or your plan members who may have to pay higher premiums. Manulife takes an industry-leading stance to prevent group benefits fraud before it happens.

Built into every Manulife group benefits plan, our Fraud Prevention Services:

Use sophisticated technology to detect unusual claim patterns

Investigate suspicious claims

Protect your plan against the overuse and abuse of prescription drugs–particularly narcotic medications

Refer cases to law enforcement and regulatory bodies when appropriate

To minimize fraud and its costs, we:

Analyze millions of claims submitted electronically and on paper quickly and efficiently

Mine data in our extensive archives to flag changes in billing and treatment behaviours, as well as the use of narcotics

Draw on the expertise of a team of skilled fraud examiners, data analysts, health and dental consultants and law enforcement professionals

Solicit information from our claims and call centre staff who are trained to spot altered claim forms, suspicious charges and unusual claim frequency

Review, analyze and audit the use of prescription narcotics with our proprietary risk assessment model and our Narcotics Utilization Claims Analysis Tool (NUCAT) to help identify and limit the potential risks associated with the misuse and abuse of narcotics

Pursue financial recoveries and prosecution through our Business Integrity department

Advise plan sponsors on how to prevent future incidents and reduce the potential for fraud and abuse

Choose your group benefits plan

Speak to your Manulife representative to discuss group benefit plan options to help meet your business needs. 

Suspect fraud?

 

Frequently asked questions

  • Build fraud prevention into plan design using co-payment plans, limits for commonly abused services and combined maximums 
  • Support plan member education and communicate clearly and forcefully that people who commit fraud are stealing from your plan
  • Understand the need for claim audits
  • Refer all tips and information about suspected fraud to Manulife through our confidential phone line (1-877-481-9171) or email address

Our fraud prevention program protects our plan sponsors by performing prepayment audits and post payment investigations. The prepayment audits mean questionable claims are not paid and the plan is protected from incurring the expense. When recoveries are made after the claim has been paid, all recoveries attributed to the claim are returned to the plan sponsor. And because this service is built into the plan, there are no costs or fees.

  • Keep benefits cards and information in a safe place
  • Review Explanation of Benefits claim statements
  • Never sign blank claim forms, and report providers who ask for them
  • Check health care practitioners are licensed by the appropriate regulatory body
  • Complete claim audit questionnaires promptly if they receive one
  • Refer all tips and information about suspected fraud to Manulife through our confidential phone line (1-877-481-9171) or email address

There are numerous types of fraud, including everything from false and altered receipts submitted by plan members to exaggerated and fake claims submitted by service providers.

Excessive billing and over-billing to the plan are common forms of abuses, and while not categorized as fraud, abuse is equally damaging to your plan. Narcotics abuse is also a serious concern for both the plan member’s health and the sponsor’s plan costs.

Because Manulife is bound by federal and provincial privacy laws we’re not always able to let you know when we suspect that fraud is taking place. However if the evidence is strong enough or we acquire an admission from the plan member, you may be advised.

Have a question?

Contact us