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Healthcare fraud is hurting you and your family – Help stop it

March is Fraud Prevention Month across Canada. Recognize it, Reject it, Report it!

Through a combination of private and public coverage, Canadians enjoy one of the most comprehensive systems of healthcare benefits on the planet. We should rightly be thankful for this privilege, but we should also be careful to ensure that we continue to enjoy it into the future.

Much has been made in recent years about the sharp increase in spending on prescription drugs, both by the governments and by private companies in the premiums they pay to offer drug plans to their employees. Many employers are reaching a breaking point, where they are being forced to consider scaling back the benefits they offer.

     Read: High-cost drugs put valuable employee benefit at risk 

There are a variety of strategies that can and are being used to limit spending increases and make drug plans more sustainable in the long term. One logical step we can all help with is to curb fraud in the system, so more of our healthcare dollars are going where we need them.

According to the Canadian Life and Health Insurance Association (CLHIA), as much as 10% of all healthcare claims in Canada are believed to be fraudulent. That means that each year, billions of dollars are being drained from a system that already struggles to remain sustainable. 

Health benefits fraud can take many forms. Patients can fake illnesses to get a prescription; Patients with legitimate conditions can sell their medication; Unscrupulous doctors can write prescriptions that are not medically necessary; and Fraudsters can pose as patients, doctors, or both.

     Read: Health care fraud hurts everyone. Here are 10 tips that will help you combat fraud

If you care about the long-term sustainability of your prescription drug plan, there are steps that you can take to help prevent fraud.

Patients:

  1. Protect your personal information. Specifically, your signature, health card number anddrug card number.

  2. Don’t give anyone your drug card for any reason.

  3. Check your receipts and Explanation of Benefits (EOB) statements. Call your insurance if you have questions.

  4. Request your pharmacy drug claims history annually. Know the medications you are on, and ask questions if you are unsure of any medications listed on your profile.

  5. Never sign your name to a blank insurance claim form.

  6. Don’t give blanket authorization to the provider to bill for services rendered

  7. If you suspect fraud, contact your insurer.

Healthcare Providers:

  1. If you are a prescriber, protect your prescription pad.

  2. Whether you work for yourself or for someone else, check all claims submitted in your name.

  3. If you will no longer be working for a particular clinic, remove the clinic from your profile at the college and alert insurers to the change.

  4. If you suspect fraud, contact the insurer.

Together, we can make sure that our healthcare dollars are only used for legitimate health claims. This will go a long way to ensuring the sustainability of our health benefit plans today and tomorrow.

Express Scripts Canada