Attending an understanding of benefit fraud to work toward recognition and prevention, offered through Sun Life Financial, the speaker used an apt example to explain how fraud happens.
During the annual parade of costumed children on Halloween, many households now use the “self-serve” method of putting a bowl on their front stoop for children to help themselves to the offered candy rather than distributing the candy a piece at a time to each caller.
The expectation
The understanding symbolism of the bowl is that each child (assumed under the age of 12) will take only one piece each. Yet, we have come to expect a few different items in this approach.
1) That there will be a child in the crowd who will take more than one piece.
2) That there will be an over-aged indulger.
3) That there will be one who will empty the container into their sack leaving nothing for anyone else.
4) That there will someone to come behind the thief and be disappointed that there is nothing.
5) That there will be one in the crowd to follow who will feel bad for the sorry state of the empty bowl and knowing what likely happened will take something from their sack and put in the bowl.
6) That there will be someone to come behind this generous child and take that last morsel.
Surprised?
We are not shocked by this turn of events, except for maybe the child who added to the bowl. In fact, isn’t it more astonishing that the first child didn’t empty the bowl and why we—the adults | parents—expect the bowl of goodies to last more than a couple of children in. To add to that, why the child who added a treat back to the empty bowl is actually so surprising when in fact, when we allow fraud to happen at all, that is in fact what we are all doing. We keep adding to the bowl allowing the perpetrator to keep taking at will.
Why would we expect that fraudsters have limits and that they will only take so much and stop?
In reality, without taking the time to be informed, you may be a participant.
Due to lack of funds, or a mindset that the insurers have more than enough money to spare, people who would otherwise never consider breaking the law or thieve, may intentionally submit false or misleading information on a benefit claim. Fraud in benefits is a real crime and there are consequences.
Did you know?
The Canadian Health Care Anti-fraud Association estimates that 2% to 10% of total health care spending in Canada results from fraud. This means that fraud may represent anywhere from $440 million to $2.2 billion in losses annually.
Where do you stand?
Are you the kid only taking the one item from the bowl, or are you the one taking all the candy and potentially the bowl as well? In the end, we are all the kid adding to the bowl…how? Because there are consequences for these actions:
· Cost fraud causes insurance premiums to increase and usually to combat the rising costs, employers will reduce coverage and that costs consumers in out-of-pocket after tax expenses or with no access to care.
· Health services are also a concern. If the provider submits for claims never incurred, but show on the patient’s health records, that may put someone in jeopardy when they have a legitimate health condition or even the ability to get insurance in the future.
· Criminal activity has real consequences. Loss of job, financial impacts in fines and retribution, jail time, and perhaps a criminal record and social stigma.
Be aware | responsible.
· Check your coverage to understand what amounts are paid out of pocket and not reimbursed under the benefit plan.
· Choose providers that do not offer inappropriate incentives. Remember, if it doesn’t make sense, or looks too good to be true—well, it likely is.
· Report service provider who offer to waive amounts not covered under from your benefit plan or offer to reimburse any portion for coverage that you are not receiving.
· Check the explanation of benefits on your profile to confirm the services and products claimed are accurate.
We’d be pleased to engage in a meaningful conversation on this and other benefit topics. Give us a call.
Note: this was written without the aid of Artificial Intelligence (AI)
Disclaimer: Please note that the information provided, while authoritative, is not guaranteed for accuracy and legality. The site is read by a world-wide audience and employment, taxation, legal vary accordingly. Please seek legal, accounting and human resources counsel from qualified professionals to make certain your legal/accounting/compliance interpretation and decisions are correct for your location. This information is for guidance, ideas, and assistance.
