Benefits fraud refers to any form of misuse by plan members or inappropriate billing and treatment practices by providers. These various elements of fraud result in increased benefit costs for employers and their plan members. To protect benefit plans against fraud, Empire Life’s investigation team deploys our profiling and analytics tools, data analysis, rules-based fraud alerts, and leverages our robust provider registry to identify any suspicious claim patterns.
While Empire Life has a number of tools and best practices to protect benefits plans, here are a few additional tips for members to help protect their plan:
- Keeping the benefits plan access information confidential.
- Ensuring receipts are correct and reflect services received.
- Never signing a blank claim form.
- Reviewing the explanation of benefits statement carefully to ensure services displayed are received
- Using the Find a Provider tool to locate an approved Empire Life Provider to verify if the provider is licensed with the appropriate regulatory agency or association.
If you see suspicious claim activity or if you have questions about fraud or abuse, contact the Empire Life confidential tip line at 1 800 267-0215, or email us at claims.investigations@empire.ca.
