​Fraud Prevention and Reporting

Fraud prevention and detection is everybody’s business!

Everywhere in the world, fraud is a major problem. In 2018, Statistics Canada reported a 12% increase in fraud-related crime. Studies show that companies lose an average of 5% of their annual business volume to fraud, all categories combined.

Fraud has serious consequences...

Did you know that 75% of Canadians mistakenly believe that the only consequence of group insurance fraud is a higher premium or having to reimburse the amounts in question (Environics Research survey for CHLIA)? A higher premium isn’t the only consequence of fraud. There are others:

  • Decrease in coverage
  • Notifications to the employer of the employee at fault
  • Disclosure to professional orders
  • Removal from the list of recognized professionals
  • Legal proceedings

We all have a role to play in the fight against this growing problem and limit negative impacts.

We've taken steps to prevent fraud!

In keeping with its high ethical, integrity and transparency standards, SSQ Insurance has a rigorous policy in place along with a specialized multidisciplinary team trained in fraud detection and prevention. In addition to the checks that are performed automatically by our claim management system, a team of auditors, data analysts and professionals analyzes claims as they are processed daily in order to detect cases of fraud or abuse.

SSQ Insurance has also implemented an external independent process for collecting and processing reports of fraudulent, abusive or suspicious behaviour.

Actions taken to dissuade fraudsters

 

Procedures for recovering amounts paid

 

Formal complaint to professional association (service provider)

 

Legal recourse

 

Termination or cancellation of the insurance contract

 

Suspension of payment card and online claims privilege

 

Removal from SSQ Insurance’s list of approved service providers

 

Notice to employer

Your role in fraud prevention

You play an essential role in fraud prevention. You can detect, avoid and also report fraud.

Detect

  • Be wary of service providers trying to use your insurance details to bill products and services that you have never received.
  • Check your statements.
  • Don’t sign blank forms.

Avoid

  • Protect your personal information including information related to your insurance.
  • Know what your protections are and the maximums provided for under your plan.
  • Keep your insurance card in a safe place and never allow anyone to use it to receive services or products.

Report

  • Report abusive or fraudulent situations so that our investigation teams can investigate and take action if necessary.

How SSQ Insurance’s community can report concerns regarding fraud, abuse or wrongdoing?

Anyone with a doubt or concern regarding fraud, abuse, wrongdoing or suspicious behaviour may submit their concerns via the external hotline operated by the firm KPMG, chosen by SSQ Insurance to ensure independence. The hotline may be accessed as follows:

By confidential email :

[email protected]

By telephone confidentially or anonymously :

1 866 777-3694

Confidentially

SSQ takes all necessary steps to maintain the confidentiality of all transmitted information and documents.

In addition, only limited access to the information and restricted use is allowed.

Anonymously

Used to describe someone who wants to protect their identity.

While you may remain anonymous, be aware that it may be difficult to obtain the details necessary to conduct an investigation.

If you wish to remain anonymous, make sure that the documents or information you transmit does not contain any personally identifiable information.

We will take the necessary measures to ensure the confidentiality of the reporting and the identity of its authors, except in the event renunciation of the latter or if we are required by order of a court to reveal his identity.

Moreover, SSQ Insurance agrees not to take any action against someone who has expressed a concern in good faith.

National program for the fight against fraud

Intentionally submitting misleading or erroneous information about health or dental care received under a group insurance plan is fraud.

To address this issue, the CLHIA put together an aware-raising program called “Fraud = fraud” to teach how to recognize it, to refuse it and to report it.

Zero tolerance!

Fraud, abuse or wrongdoing is unacceptable! SSQ Insurance will not tolerate any dishonest or unethical behaviour, actions carried out in bad faith, deception, corruption or intentional falsification by employees, clients, partners or suppliers.

Definition

Examples

Fraud :
Any illegal act or omission in bad faith characterized by deception, dissimulation, intentional falsification or a violation of trust.

Fraud is perpetrated by individuals and organizations with a view to obtaining money, assets or services, hindering the functioning of an organization, damaging its image or reputation or acquiring a personal or commercial benefit.
  • Intentionally falsifying data
  • Falsifying cheques
  • Making a false declaration or omitting to provide complete and accurate information
  • Falsifying accounting ledgers, supporting documents or other documents

Abuse :
Excessive use of contractual provisions or entitlements or unethical circumventing of rules.
  • Asking a supplier to produce an invoice on a spouse’s behalf after having reached their refund limit.
  • Claiming services that were billed for more than the amount paid for

Wrongdoing :
Intentional or suspected violation of laws and regulations or serious breach of codes of ethics.
  • Violating code of ethics or other laws and regulations
  • Failing to declare conflict of interest