Benefits fraud occurs, according to the Canadian Life and Health Insurance Association (CLHIA), when someone “intentionally submits false or misleading information to an insurance provider for the purpose of financial gain. It can take many forms.
Examples include (but are not limited to):
- Billing for health or dental services that were never received
- Submitting the same claim to multiple insurers to double your reimbursement
- Letting someone not covered by your plan use “your benefits.”
A finding of fraud or abuse can have serious consequences for health care professionals. It can and has resulted in major insurance providers delisting health care professionals and their clinics, for an indefinite period. It can also result in loss of reputation, income or even the loss of your license to practice chiropractic care.