For small organizations, offering employee health benefits can be a challenge. But being a smaller company doesn’t mean a benefits plan is out of reach. Fortunately, there are simple ways for employers to create the plan that’s best for their organization without breaking the bank.
Have you ever thought:
- Using your group benefits dishonestly for your own advantage is no big deal;
- You pay high premiums for group benefits and you’re entitled to use them so you don’t lose them; or
- You could change the date on your receipt so you can be paid back the full amount of your claim?
Whether it’s falsifying a one-time claim, or a larger ongoing scheme, benefits fraud of any kind is still considered fraud. It’s a real crime with real consequences.
With an understanding of what group benefits fraud looks like, you can help stop benefits fraud. By learning how to recognize the warning signs of benefits fraud, you can refuse and report it.
Know the facts about group benefits fraud so you can recognize it, refuse it and report it. Below are answers to some of the frequent questions about benefits fraud. If you have more questions, reach out to Equitable Life’s Special Investigations Unit.
When it comes to fraud, group benefits fraud is likely not even on your radar. Which begs the question, why does benefits fraud matter? Surely a few rogue claims won’t hurt your employer or impact the premiums you pay?
Three factors which can cause providers and plan members to commit fraud are entitlement, opportunity and rationalization. Together, these three factors make up the commonly recognized fraud triangle that can contribute to the desire to commit fraud.
Together, advisors, plan members, employers and insurers share in the responsibility of protecting health benefits plans from fraud and abuse. Here are some tips to help you recognize, report and reject health benefits fraud.