"If you saw somebody walking out with an iPad that the employer had bought, you would be offended by that. "We wouldn't think it's acceptable to steal from our employer outright," he says. He's seen employees collect all manner of goods. Green Shield's Brent Allen says providers often encourage scam participants to max out on their plans' provisions. Sun Life's Dave Jones says the company's fraud team includes close to 100 investigators, some of them former police officers, others are data scientists. "They'll say there's no need to worry about getting caught, because they know the provider, and if the insurance company calls them, they will validate the claim."Īskin refers to fraud ring organizers as "recruiters" and says the schemes can grow quickly, as employees reap rewards and spread the word. "You're sitting in the lunchroom when a co-worker comes in and says, 'I've got $1,000 worth of massage receipts, $2,000 worth of physiotherapy receipts, submit them all, and we can share the money,'" explains Gary Askin, a former commander with the Waterloo, Ont., police force who now works as a fraud investigator with Sun Life.Ĭash, cash cards, purses, designer sunglasses, coats and iPads are examples of what people have been able to get with fraudulent health benefit claims. Employers and their insurance providers are reeling at the proliferation of fraud rings - groups of employees who work together to abuse and exploit benefit plans, with medical services providers as their eager accomplices.
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