Health Care Fraud Prevention

Prevention starts with you.

Protect yourself against health care fraud by being a smart consumer of health care services. You’ll reduce health care fraud and protect the viability of your Saskatchewan Blue Cross benefit plan.

If you suspect potential plan abuse or improprieties (that may include health care fraud), report it to us immediately.

Be cautious of co-payment waivers, advertisements stating “covered by insurance” or services claiming that they are covered by insurance rather than based on need.

Think of your health benefits card as being as valuable as a credit card. If lost or stolen, a health care card could be used for identity theft or to gain access to drugs and services that may permanently appear on your medical history or count toward your annual or lifetime benefit maximums.

Closely examine your official receipts, invoices and claim statements to ensure that all products or services billed to you are the services you or a family member received. If there is any question or discrepancy, contact Saskatchewan Blue Cross immediately.

Types of health care fraud and plan abuse.

Identity theft
Using another person’s health benefits card or identification to obtain products or services or to impersonate that individual.

False billing
Claiming for products or services not provided, performed or received.

Forgery or alteration of documentation
Including but not limited to eligibility or claims information.

False claiming
Claiming for a more expensive product or service than was actually provided.

Double doctoring
Obtaining multiple prescriptions from more than one prescriber for the same product.

Misrepresenting services
Performing services that are not covered, then claiming for different services that are covered.

Unbundling
Claiming separately for procedures that are actually part of a single procedure.

Masquerading as health care professionals
Delivering health care and/or health care services without proper licenses.

Together we can prevent it.

The overwhelming majority of customers, health service providers and suppliers are honest and ethical in their dealings with Saskatchewan Blue Cross. Unfortunately, health care fraud sometimes does occur. Every dollar of health care fraud and plan abuse must ultimately be paid by individual plan participants and plan sponsors, which causes benefit plan costs to rise.

Saskatchewan Blue Cross has a policy of zero tolerance toward any abuse of the benefit plans we administer on behalf of our customers. We actively investigate and pursue all suspected fraudulent activities and have measures in place to detect and combat fraud.

These measures include:

  • Monitoring of claim patterns
  • Auditing to ensure compliance with plan contracts and agreements
  • Pursuing civil and criminal prosecution where evidence indicates fraudulent activity has occurred
  • Restitution where warranted

Report suspected fraud or plan abuse.

Whether you’re a plan participant, plan sponsor or health care service provider, you can play an important role in helping us prevent health care fraud and benefit plan abuse.

Contact us if you suspect any potential fraud or plan abuse, or any improprieties that may include fraudulent activity.

All information provided will be kept strictly confidential, including your identity. If you prefer, suspicions of fraudulent activity may also be reported anonymously.

Contact us.

If you suspect any potential health care fraud or benefit plan abuse, or any improprieties that may include fraudulent activity,

call us toll-free at 1-877-522-8477

email sbctips@sk.bluecross.ca

or write us at
Fraud Tips
c/o Audit Services
Saskatchewan Blue Cross
PO Box 4030

Saskatoon SK S7K 3T2