Is cheating your group insurance plan fraud?

April 30, 2019 1:59 pm

You bet it is, and carriers are — understandably — doing more than ever to educate employees that cheating your group insurance plan is fraud and will not be tolerated.

In fact, these more aggressive actions by carriers have resulted in employees being charged, and employers in turn are terminating employees who cheat their group plans. In other words, there are real, and severe, consequences for cheating.

Never before has the industry put more focus on insurance plan fraud prevention than what you’re seeing today. Ads appear on television, in magazines and in publications educating employees that any fraud is unacceptable and illegal. Carriers are investing heavily in fraud prevention as well, through the programing of algorithms in their claims systems to detect unusual activity.

Many carriers have increased their staff in this area as well; in some carrier operations, staffing in insurance plan fraud departments has jumped from 4 to 80 employees over the past five years. Add to this more sophisticated hiring practices where past police and investigative personnel form part of the insurance carriers’ team, and you can see how seriously carriers are taking their efforts to reduce fraudulent claims usage.

What does this mean to you as an employer? Fraud costs your plan money and while your carrier is doing everything they can to ensure they address all that fraud does to your plan, there are actions you can take as an employer to protect the financial interests of your plan. The three key areas of focus are as follows:

Time – take the time to treat your group plan like the important budget item it is. Too often employers don’t have or take the time to even review their plan as an important budgetary cost item. This is one of the costliest ways to manage your benefits program. As with any unaddressed budgetary item in your organization, costs will rise, and group benefits are no different.

Expertise – finding the right partner to help you manage through the tumultuous group benefits arena will save you time and money. A qualified broker partner will know how a group plan works both in underwriting and in practice and will be able to delve into what your plans drivers are, to manipulate the outcomes, and align it with the goals of your organization. A good broker partner will be nimble in offering creative solutions that will address the long-term impact of your plan financially as well as competitively.

Communication – never has communication been more important to group benefits than it is today. It’s really the key to your benefit results. Communicating between all stakeholders can greatly influence outcomes. Add to that the importance of communicating well to your employees from the onboarding stage and ongoing. Doing this right and in a format that suits your organization and your employees will domino the effects of offering a group benefits program and can improve your financial outcomes.

For more information on how to trump up your group benefit experience, please contact Rosemary Marsh at 905-777-9990, ext. 202 or via email at Our expertise is your advantage!

This post was written by Rosemary Marsh

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