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Benefits fraud

We are always on the lookout for benefits fraud and abuse. Through a combination of advanced analytics, machine learning and a dedicated audit and investigation team, we work hard to stop fraud in its tracks before it can threaten the sustainability of your plan.

Fraud prevention is a constantly evolving system. When we catch someone committing benefits fraud or abuse, we don’t just stop the crime—we learn from it. We take the lessons from every case and build them into our robust and comprehensive fraud prevention plan.

Here are some of the recent cases of benefits fraud and abuse we’ve dealt with.

Ineligible product

Mar 15, 2023

A provider dispensed ineligible products...

Learn more about the Ineligible product case study
Incorrect procedure codes

Mar 8, 2023

A provider submitted claims for ineligible services...

Learn more about the Incorrect procedure codes case study
Accessing employer information

Mar 1, 2023

A member obtained access to her employer’s group plan administration portal...

Learn more about the Accessing employer information case study
Coupled in crime

Feb 24, 2023

2 members—a couple—enrolled in group benefit plans...

Learn more about the Coupled in crime case study
Submitting false claims

Dec 30, 2020

A plan member enrolled in a group benefit plan...

Learn more about the Submitting false claims case study
Services not received

Dec 29, 2020

Two individual plan members enrolled in benefit plans with us...

Learn more about the Services not received case study

The information on this page is based on data provided by our private book of business.