Being a smart consumer of health care services means you can reduce health care fraud and protect the viability of your Saskatchewan Blue Cross benefit plan. If you suspect potential plan abuse or problems, please report it to us immediately.
What to watch for
- 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.
- Closely examine your official receipts, invoices and claim statements to ensure all products or services billed to you are for the services you or a family member actually received. If there is any question or discrepancy, contact Saskatchewan Blue Cross immediately.
- 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.
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.
- 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 fraud
The overwhelming majority of members, 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 sponsors, which increases costs to you and your employer to rise. Saskatchewan Blue Cross has a policy of zero tolerance toward any abuse of the benefit plans we administer on behalf of our members. 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 play an important role in helping us prevent health care fraud and benefit plan abuse.
Contact us directly 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.