Fraud Prevention Centre
Protect your benefits. Prevent fraud.
What is benefits fraud or insurance fraud?
Benefit fraud is the intentional misuse or overuse of your benefit plan for personal gain. Fraud drives up premiums, reduces available coverage, and can lead to suspension of benefits, financial penalties, or legal action.
Common examples of benefit fraud:
- Using a family member’s coverage for a service for you
- Providing billing for products or services you did not receive
- Submitting false claims
- Claiming services that are not covered under your plan
- Accepting gifts or incentives in exchange for claims
Recognizing and Avoiding Risky Provider Situations
Provider Fraud is another form of benefits misuse. If something feels off, it probably is. Be cautious if a provider:
Always make sure your provider is in good standing and that the claims submitted reflect the services you received.
Fraud vs Benefits Misuse: Know the Difference
Benefit misuse happens when benefits are used incorrectly, even if unintentional. Using your benefits honestly helps protect the plan for you and your colleagues.
Why it matters?
Increase costs for everyone
Puts pressure on benefit plans meaning higher claim costs which can lead to premium increases or reduced coverage
Result in reduced or suspended benefits, repayment of claims, employer notification, or even job loss
Honest Claims Keep Benefit Plans Strong
Benefit plans are dependent on accuracy. Using your benefits honestly helps protect coverage today and keeps it available for those who need it tomorrow.
Your role as a GreenShield Plan Member?
You play an important part in keeping your benefits accurate, secure, and available for everyone.
What this means:
- Submit complete and accurate information
- Report any changes that could affect your eligibility
- Submitting valid claims
- Review your benefit statements and notifications regularly
- Confirm each claim being submitted by your provider accurately reflect the services you received.
Need help or have a concern?
Protect your benefits by submitting accurate claims and speaking up if something does not look right. If you have questions, contact your employer or reach out directly to GreenShield’s Claim Watch team:
