March is Fraud Prevention Month

Take action to help protect your benefits plan from fraudulent activity. Support Fraud Prevention Month by educating your employees of the dos and don’ts of benefits fraud.  

What is Benefits Fraud?

Fraud is defined as the intentional submission of false or misleading information for the purpose of financial or personal gain. Benefits fraud occurs in many ways and the schemes are constantly evolving. While the vast majority of plan members and health care providers are honest and ethical, it is important to understand the main perpetrators of fraudulent activity. Benefits fraud is generally committed by plan members, health care practitioners and suppliers, or a combination working together in collusion to defraud benefit plans.  

Help Prevent Benefits Fraud!

  • Treat health care fraud seriously and inform plan members of the consequence of fraud - Circulate the Dos and Don’ts of Benefits Fraud flyer and post the fraud prevention poster series at your workplace
  • Inform plan members that Manulife has comprehensive fraud detection systems in place 
  • Understand and support claim audits, requests for additional information and the need for these to be completed accurately  
  • Report fraudulent activity tips or information to Manulife through our confidential tip line or by email.
  • Consider enhanced controls within benefits plan design:
    • Co-insurance and deductibles keep the plan member engaged 
    • Set maximums to reduce the overall risk 
    • Add a Health Care Spending Account to offer flexibility, while limiting plan expenses and exposure

The Benefits-Fraud-Affect

Your benefits plan is an investment for both you and your employees. Manulife’s fraud prevention program is designed to protect that investment. When fraud is committed it can lead to:

  • Financial loss - Plan members may not understand that when they commit benefits fraud they are stealing from their employer
  • Increased premiums - When inaccurate or misleading claims get paid, premiums may increase
  • Reduced coverage - Plan sponsors may choose to reduce plan coverage 
  • Conviction and permanent record - Manulife routinely submits referrals to law enforcement.  Consequences can include criminal charges, fines, and jail time 
  • Suspension of provider license - Manulife routinely submits referrals to provider regulatory colleges and associations, which can result in various disciplinary actions 
  • Delisting of providers - When Manulife has gathered evidence that providers have engaged in fraudulent and unethical activity, we will no longer pay claims related to those providers            
  • Job loss - The consequence of intentionally submitting a fraudulent claim often results in termination of employment      

Manulife is committed to protect your group benefits plan and employs strategies to prevent, detect, investigate and deter fraud. With our expert team of anti-fraud professionals, we aggressively respond to emerging risks and collaborate with law enforcement, plan sponsors, provider colleges and associations, and industry anti-fraud groups to promote fraud prevention.        

Report Fraud Now

If you suspect benefits fraud, report your concerns to gb_investigative_services@manulife.com or call our confidential tip line 1-877-481-9171.

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