CPHR Alberta Magazine - Summer 2018 - 15

The Response from
Insurance Providers
So what are the insurers doing? The
most common step right now is that
the insurers are no longer paying
out claims from providers who they
suspect of committing these offences
("known as delisting"). Unfortunately,
the damage is typically done before
there is enough evidence to delist a
provider. The more concerning aspect
of this for me as an advisor knows
the provider community (i.e. medical
supply stores, dentists, paramedical
practitioners etc.) view your plan as
a way to generate income. Providers
know employees are less likely to
use their service or buy their products out pocket, however, are very
receptive when using their benefit
plan. The dentistry industry has
become a prime example of this.
Even though they are operating
legally and ethically  - they never
miss an opportunity to proactively
book you for a check-up when your
plan allows. Now other industries
are finding ways to build revenue via
your benefit plan, and some professionals working in these industries
are using fraudulent tactics to profit.
Lastly, we have recently been
informed that one benefits provider
has helped provide incriminating
evidence on a local scam using
CPAP machines (breathing monitors). In these cases the employee
and the "provider" share in the
profits of a fraudulent claims that
were being paid, and no equipment
being provided.
All of these fraudulent claims are
having a significant impact on benefit plans, and in turn their premiums. At the very least, it is something
to be monitoring in your claims
experience going forward.
are selling a consumer items like
running shoes, as opposed to the
custom hosieries.
This whole process is not always
driven, or even given thought to,
by your employees. This is because
it is very common for the service
provider to approach the employee.
They then "educate" and "coach" the
employee on how their plan covers

these items. From the employee
perspective this can be appealing
given they often have to contribute portions of their paycheque to
plan premiums. Ethics aside, this
is happening and often spreads rapidly though a given company's plan
once the word gets out about how to
obtain these types of items through
the plan.

Matt Fraser has spent the last 14 years
as a Group Benefits Consultant at
Silverberg Group. Having continuously challenged the status quo Matt
has pushed past the normally accepted
results many employers and insurers
have considered the standard, allowing
him to become a leader in the area of
claims and expense management.
CPHR Alberta Magazine | Issue 2 | 15



Table of Contents for the Digital Edition of CPHR Alberta Magazine - Summer 2018

Leadership Matters
A Vision for 2018 Workplaces
Cultivating a Culture of Innovation: Innovation is People!
Do You have these Types of Fraudulent Claims on Your Benefits Plan?
How to Avoid ‘Career Misery’ in Your Workplace
Legal Corner: Rolling Out New Employment Contracts?
Legal Corner: Demystifying Constructive Dismissal
Legislation Update: Is Pay Equity Legislation Coming to Alberta?
Suppliers’ Guide
Index of Advertisers/Advertisers.com
CPHR Alberta Magazine - Summer 2018 - Intro
CPHR Alberta Magazine - Summer 2018 - cover1
CPHR Alberta Magazine - Summer 2018 - cover2
CPHR Alberta Magazine - Summer 2018 - 3
CPHR Alberta Magazine - Summer 2018 - 4
CPHR Alberta Magazine - Summer 2018 - Leadership Matters
CPHR Alberta Magazine - Summer 2018 - A Vision for 2018 Workplaces
CPHR Alberta Magazine - Summer 2018 - 7
CPHR Alberta Magazine - Summer 2018 - 8
CPHR Alberta Magazine - Summer 2018 - 9
CPHR Alberta Magazine - Summer 2018 - Cultivating a Culture of Innovation: Innovation is People!
CPHR Alberta Magazine - Summer 2018 - 11
CPHR Alberta Magazine - Summer 2018 - 12
CPHR Alberta Magazine - Summer 2018 - 13
CPHR Alberta Magazine - Summer 2018 - Do You have these Types of Fraudulent Claims on Your Benefits Plan?
CPHR Alberta Magazine - Summer 2018 - 15
CPHR Alberta Magazine - Summer 2018 - How to Avoid ‘Career Misery’ in Your Workplace
CPHR Alberta Magazine - Summer 2018 - Legal Corner: Rolling Out New Employment Contracts?
CPHR Alberta Magazine - Summer 2018 - Legal Corner: Demystifying Constructive Dismissal
CPHR Alberta Magazine - Summer 2018 - 19
CPHR Alberta Magazine - Summer 2018 - 20
CPHR Alberta Magazine - Summer 2018 - Legislation Update: Is Pay Equity Legislation Coming to Alberta?
CPHR Alberta Magazine - Summer 2018 - Suppliers’ Guide
CPHR Alberta Magazine - Summer 2018 - 23
CPHR Alberta Magazine - Summer 2018 - 24
CPHR Alberta Magazine - Summer 2018 - 25
CPHR Alberta Magazine - Summer 2018 - Index of Advertisers/Advertisers.com
CPHR Alberta Magazine - Summer 2018 - cover3
CPHR Alberta Magazine - Summer 2018 - cover4
CPHR Alberta Magazine - Summer 2018 - outsert1
CPHR Alberta Magazine - Summer 2018 - outsert2
CPHR Alberta Magazine - Summer 2018 - outsert3
CPHR Alberta Magazine - Summer 2018 - outsert4
CPHR Alberta Magazine - Summer 2018 - outsert5
CPHR Alberta Magazine - Summer 2018 - outsert6
CPHR Alberta Magazine - Summer 2018 - outsert7
CPHR Alberta Magazine - Summer 2018 - outsert8
CPHR Alberta Magazine - Summer 2018 - outsert9
CPHR Alberta Magazine - Summer 2018 - outsert10
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