Let's shut the door on group insurance fraud
Preventing and reporting fraud
How to report fraud
What is a suspicious situation?
Here are some examples of situations you could report:
- a deliberate act to falsify documents and claims
- abuse of existing rules
- an unintentional error in the information provided
How can you protect yourself against fraud?
You too can contribute to fraud prevention. These guidelines will help you detect fraud and steer clear:
- Only do business with healthcare professionals who are members of their order or association.
- Check your online claims history and statements regularly.
- Protect your personal information.
- Keep your service card in a safe place.
- Visit your Client Centre for the list of associations, establishments and healthcare professionals we've excluded.
- Don't sign a claim form in advance and report any healthcare professional who offers you one.
What we're doing to prevent fraud
Every year, our prevention team detects numerous cases of group insurance fraud.
We don't take it lightly. Quite the opposite. We have set up dissuasive measures to prevent it.
Measures for insured persons:
- recovering overpayments
- verification of past claims
- suspension of service card and online claims privilege
- termination or cancellation of the insurance contract
- notice to the employer
- legal recourse
Measures for healthcare professionals:
- removal from our list of recognized professionals
- formal complaints to professional orders or associations
- legal recourse
Fraud prevention affects everyone: the people we insure, the plan sponsors who trust us, and the healthcare professionals we work with.
Preventing fraud allows us to limit group insurance cost increases. Everyone pays the right price, fair and square.
La Capitale and SSQ Insurance
Make yourselves at home