Fraud can threaten your plan sustainability
What’s often lost in the discussion of fraud are the long-term consequences. It might appear to be harmless, but it often results in escalating plan costs and reduced benefits coverage for you and your family. We’ve invested in fraud prevention and it’s a central focus of our day-to-day operations.
Fraud can be an ongoing challenge. Despite the fact that most of our customers and health service providers are honest and ethical, it’s no secret that fraud can sometimes still occur.Find out if your provider is eligible
You're the first line of defense in addressing fraud
Do your part to help reduce fraud and protect the long-term viability of your Alberta Blue Cross benefit plan.
- Never give anyone your policy numbers or other information about your benefits plan.
- Never sign a blank claim for and review anything you do sign to make sure all the information is correct. Always ask for copies of any form you sign.
- Never allow anyone to submit a claim on your behalf before receiving the service or product.
- Check your receipts, make sure they are correct and keep them for two years.
- Never accept credit for services or products you have not yet received and do not substitute products or services for something not covered under your benefits plan.
We don't just react—we take an integrated and proactive approach to fraud prevention.
Strict and robust systems
- Ultimately, we believe every dollar lost to healthcare fraud and plan abuse is a dollar too much. When it comes to the plans we administer, we have a zero tolerance policy.
- We terminate agreements and deem providers ineligible.
- We pursue civil and criminal prosecution where evidence indicates fraudulent activity has occurred and restitution where warranted.
- To view the current list of ineligible providers, simply sign in to your member account and click the "Ineligible providers" link.
- A dedicated Claims Assurance team continually evaluates the nature of the claims we receive and looks for patterns in claiming behavior.
- Our experts collaborate to identify and address suspicious or concerning trends as early as possible.
- Advanced analytics data for various categories allows us to identify outliers from typical patterns.
Flexibility and control
Our approach involves innovative plan management strategies
Evolved relationships with external partners
Combating fraud is a collaborative effort - we work with our health service providers, plan sponsors, advisors and members to educate and create awareness around fraud prevention to ensure that we're minimizing both its frequency and its long-term consequences.
What are the consequences of committing fraud?
Health care fraud is illegal. People who commit it can face criminal prosecution and may receive fines or jail time. Plan members who receive benefits through their employer can put their employment at risk. Committing fraud can also affect a plan member’s future ability to be insured, through either Alberta Blue Cross or another benefits provider.
Health care fraud affects everybody, even those who do not commit it. Fraud can lead to
- increased benefit costs and premiums while reducing benefit packages and coverage under benefits plans;
- inaccurate or false records being created which could affect a plan member's ability to be insured, either through Alberta Blue Cross or another benefits provider; and
- reimbursement of claims paid by a plan member being denied.
Health care fraud is an intentional deception or misrepresentation that the individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual, or to the entity or to some other party.
- National Health Care Anti-Fraud Association
Report fraudulent activity
If you've noticed suspicious or fraudulent activity, please contact our fraud hotline at 1-866-441-8477 (toll free).
Alternatively, you can send a report online using our Alberta Blue Cross Fraud, Privacy and Ethics Reporting service. All information—including your identity—is kept strictly confidential and suspicions of fraudulent activity can be reported anonymously.Fill out a report