Quick Contact
Ottawa office
466 Tremblay Road
Ottawa, ON K1G 3R1

Tel: 613-231-2266
Fax: 613-231-2345
Toll Free: 1-888-613-1234
Winnipeg office

Mailing address:
P.O. Box 764
Winnipeg, MB R3C 2L4

Street address:
Unit 1391,
1403 Kenaston Blvd.
Winnipeg, MB R3P 2T5

Tel: (204) 942-4438
Fax: (204) 943-5998
Toll Free: 1-888-204-1234

Fraud Protection

Benefits fraud is a real crime that has real life consequences for offenders and innocent plan members. The Canadian Life and Health Insurance Association (CLHIA) recently launched an anti-fraud website that explains it all. CHLIA notes that hundreds of millions of dollars are lost to health care fraud in Canada each year. A significant portion of that is borne by Canadian employers who sponsor benefit plans. Visit fraudisfraud.ca to find out more.   

To protect benefit plans from potential fraud, Coughlin declines claims from health and dental service providers who demonstrate irregular or suspicious billing activity.  This is done in an effort to better protect our clients’ benefit plans from potential fraud. This process is called delisting.

As part of our anti-fraud strategy, we are also pleased to share our Be Fraud Smart brochure that provides tips and advice on how to spot potential fraud.  Click here to download it now.  


Fraud management has played an increasingly important role in helping to contain costs under group benefits plans. Coughlin and Associates takes fraud seriously.

 

We undergo significant actions to minimize fraud including:

  • Analyzing and auditing submitted claims;
  • Monitoring billing, treatment and narcotics usage against national benchmarks;
  • Employing and partnering with skilled fraud examiners, data analysts, health and dental consultants and law enforcement professionals;
  • Providing education to ensure our employees can identify fraudulent claims easily and are up-to-date on emerging fraud trends;
  • Pursuing financial recoveries and prosecution as necessary;
  • Investigating and delisting providers that:
    • Use unlicensed professionals to perform services
    • Provide unnecessary medical products, supplies or services
    • Bill for undelivered services or products
    • Knowingly participate in collusion schemes
    • Offer inappropriate incentives contrary to their code of ethics and / or
    • Perform other fraudulent acts
  • Developing strategies to identify and prevent future incidents that reduce the potential for fraud and abuse.

Managing fraud is critical. Although our fraud detection strategies are always evolving, we need your support to protect plan sponsors and members against fraud.


Suspect something? Contact us.

 

tipline@coughlin.ca

Tip line: 1-833-358-4262

To ensure your anonymity, our fraud experts do not collect or disclose your personal information.

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