Helping you keep your plan safe from fraud and abuse

February 20, 2017

Next month (March) is fraud prevention month in Canada, which is of course a perfect time to reflect on the ways GSC tackles benefits plan fraud and abuse head on – before it impacts you. We’re continually exploring ways to expand our fraud prevention, control, and detection practices, which are built into all aspects of plan design and administration.

A great example of fraud prevention is our Find a Provider tool, available on Plan Member Online Services and the GSC on the Go® mobile app. Each health provider is uniquely registered and profiled on the GSC claims adjudication system. Once we determine whether a health provider is in good standing with their provincial association or professional college, and therefore eligible to bill GSC directly, they are listed on the tool – allowing plan members to find a health provider near them who is recognized and approved by GSC. And it doesn’t stop there. We continue to monitor provider practices and interpret the provider’s claims data to identify abnormal billing patterns, service over-utilization, and excessive fees before they escalate into larger issues.

Using the results, we apply rankings to each health provider in our system. When a concern is raised, the rankings allow us to process a claim in a different manner – for example, pending the claim to verify the services were delivered prior to releasing payment, or requesting additional information. Then we can proactively detect and monitor potential fraudulent activity, and make sure only these GSC approved health providers show up in the Find a Provider search results.

Looking for more information on the Find a Provider tool? We’ve created new fact sheets for you and your plan members. Just ask a member of your GSC account team.