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Healthcare Fraud:It’s Not My Problem, Is It?           Canadian Health Care Antifraud Association
Canadian Health Care Anti-fraud                      Association                VisionTo improve the Canadian Health Caree...
Canadian Health Care Anti-fraud                       Association                  MissionOur mission is to combat health ...
Membership
Health Care Fraud - What Is It?Three Key Elements:•Intent•Misrepresentation•Purpose                              5
Health Care Fraud - What Is It?Common Frauds:•Identity Theft•Fabricated Receipts•Misrepresented Claim Details•Unauthorized...
Fraud Myth #1“Canada Doesn’t Have a Fraud Problem!”Where there is money, there is someone that wantsto get that money even...
Fraud Myth #2“The Insurance Company Just Doesn’t Want to PayThe Claim!”Insurance carriers are obligated, contractually and...
Fraud Myth #3“Insurance Carriers Always Think It Is the ProviderCommitting Fraud!”Absolutely Not! The carriers have seen s...
Fraud Myth #4“I’d Know It If Someone Pretended to Be Me!”The Fraudster will do everything possible to makesure that doesn’...
Fraud Myth #5“The Insurance Company Will Recognize If TheySee a Different Receipt For Me.”Millions and millions of claims ...
Fraud Myth #6“My Patient Wants Me to Use a Different Date onThe Receipt, What’s The Harm?”Different date, different patien...
Fraud Myth #7“My Patient Would Never Change My Receipts!”Altered receipts are not uncommon.There are things you can do to ...
Contact Us     Canadian Health CareAnti-fraud Association (CHCAA)      http://www.chcaa.org/   Phone 416-593-2633  e-mail ...
CHCAA - Healthcare Fraud Myths
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CHCAA - Healthcare Fraud Myths

7 myths about healthcare fraud in Canada.

Review the the Best Practices to fight health care fraud:
http://www.slideshare.net/CHCAA_Canada/chcaa-best-practices

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CHCAA - Healthcare Fraud Myths

  1. 1. Healthcare Fraud:It’s Not My Problem, Is It? Canadian Health Care Antifraud Association
  2. 2. Canadian Health Care Anti-fraud Association VisionTo improve the Canadian Health Careenvironment by eliminating health carefraud.
  3. 3. Canadian Health Care Anti-fraud Association MissionOur mission is to combat health care fraudand assist in restoring the integrity of theCanadian health care system.
  4. 4. Membership
  5. 5. Health Care Fraud - What Is It?Three Key Elements:•Intent•Misrepresentation•Purpose 5
  6. 6. Health Care Fraud - What Is It?Common Frauds:•Identity Theft•Fabricated Receipts•Misrepresented Claim Details•Unauthorized Alterations of Receipts 6
  7. 7. Fraud Myth #1“Canada Doesn’t Have a Fraud Problem!”Where there is money, there is someone that wantsto get that money even if not entitledNo verifiable statistics but studies suggest could be3% of healthcare dollars which could mean over $4billion of the over $135 billion in public healthcareexpenditures may be fraudExcludes private payor and patient out-of-pocket dollars 7
  8. 8. Fraud Myth #2“The Insurance Company Just Doesn’t Want to PayThe Claim!”Insurance carriers are obligated, contractually andlegally, to process claims as your patient’semployers directs themIncreasing utilization of benefits, especially in tighteconomic times, forces your patient’s employers tomake tough decisions about what they can offer inemployee benefit plans
  9. 9. Fraud Myth #3“Insurance Carriers Always Think It Is the ProviderCommitting Fraud!”Absolutely Not! The carriers have seen so manytypes of fraud by so many different people that theydo not assume anything.
  10. 10. Fraud Myth #4“I’d Know It If Someone Pretended to Be Me!”The Fraudster will do everything possible to makesure that doesn’t happen.
  11. 11. Fraud Myth #5“The Insurance Company Will Recognize If TheySee a Different Receipt For Me.”Millions and millions of claims are processed inCanada each yearMore and more claims are processed electronicallywithout being viewed by a personWould cause massive delay in claim payment tocheck receipts
  12. 12. Fraud Myth #6“My Patient Wants Me to Use a Different Date onThe Receipt, What’s The Harm?”Different date, different patient, different service - nodifference - misrepresentationKnowingly issuing a false document may result incriminal charges.
  13. 13. Fraud Myth #7“My Patient Would Never Change My Receipts!”Altered receipts are not uncommon.There are things you can do to reduce this potential
  14. 14. Contact Us Canadian Health CareAnti-fraud Association (CHCAA) http://www.chcaa.org/ Phone 416-593-2633 e-mail info@chcaa.org

7 myths about healthcare fraud in Canada. Review the the Best Practices to fight health care fraud: http://www.slideshare.net/CHCAA_Canada/chcaa-best-practices

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