Fraud Prevention and Reporting
The number of cases of abuse, fraud and suspicious behaviour in insurance and financial services has risen in recent years. This can have a negative impact on customers and in the industry.
To encourage ethical behaviour, integrity and transparency, SSQ Insurance has set up an independent external process to identify and handle the reporting of abuse, fraud and suspicious behaviour. SSQ is also actively involved in the prevention and detection of such activity.
What should be reported?
Employees, customers, partners and suppliers of SSQ Insurance and any person directly or indirectly involved with SSQ Insurance may report any and all concerns regarding fraudulent behaviour, such as:
- Making a false declaration or omitting to provide complete and accurate information
- Claiming services that were billed for more than the amount paid for or that weren't rendered
- Performing services not required by a diagnosis for the purpose of making a claim
- Falsifying accounting ledgers, supporting documents or other documents
- Violating accounting practices, codes of ethics or other regulations
How do I report cases of fraud, abuse, and inappropriate behaviour or share my concerns about them?
To report the inappropriate behaviour of an insured member or a provider, please write to firstname.lastname@example.org, or call 1-888-900-3457, ext. 69200.
To report the appropriate behaviour of an SSQ Insurance employee or manager, or to share your concerns with us, please write to email@example.com, or call1-866-777-3694.
All information received will remain confidential. If you wish, we will ensure your anonymity.
All reported concerns will be dealt with promptly and professionally.
What are the means in place to prevent fraud and abuse?
In addition to the checks that are performed automatically by our claim management system, a team of auditors, data analysts and professionals analyzes requests as they are processed on a daily basis in order to detect cases of fraud or abuse.
National Anti-Fraud Program
Intentionally submitting erroneous or misleading information related to health or dental care received through an employer’s group insurance plan is fraud. It’s wrong to think that the only consequences of group insurance fraud are higher premiums or simply reimbursing a defrauded amount.
With this in mind, the Canadian Life and Health Insurance Association (CLHIA) created the Fraud = Fraud program, designed to teach consumers to recognize it, reject it and report it.