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Reporting suspected

fraud or plan abuse.


Consumers and health care service providers
are often the first line of defense in battling
health care fraud. Whether youre a plan
participant, plan sponsor or health care service
provider, you play an important role in helping
to combat suspected fraud and plan abuse.

If you suspect any potential fraud


or benefit plan abuse, or any
improprieties which may include
fraudulent activity, please contact us

Please contact Saskatchewan Blue Cross


if you suspect any potential fraud or plan
abuse, or any improprieties which may
include fraudulent activity. With your
assistance, we can prevent health care
fraud and benefit plan abuse.

All information will be kept strictly confidential,
including your identity. Suspicions of fraudulent
activity may also be reported anonymously to
the address listed on the back of this brochure.

Toll free at: 1.877.522.8477

sbctips@sk.bluecross.ca

Fraud Tips
c/o Audit Services
Saskatchewan Blue Cross
PO Box 4030
Saskatoon SK S7K 3T2

Saskatoon Office

Regina Office

516 2nd Avenue North

100-1870 Albert Street

PO Box 4030

Regina SK S4P 4B7

Saskatoon SK S7K 3T2



Phone 306.244.1192

Phone 306.525.5025

Fax 306.652.5751

Fax 306.525.2124

Our business hours are 8:30am to 5:00pm weekdays.

www.sk.bluecross.ca

Saskatchewan Blue Cross is a registered trade-mark of the


Canadian Association of Blue Cross Plans, used under licence by
Medical Services Incorporated, an independent licensee.
MSI 591 - 2500 - 08/08

Prevention
starts with you.
Health care fraud and
benefit plan abuse hurts
you more than you know.

Preventing fraud and plan


abuse starts with you.

Types of health care


fraud and plan abuse.

Protect yourself against health care fraud by


being a smart consumer of health care services.
Youll help reduce health care fraud and protect
the viability of your Saskatchewan Blue Cross
benefit plan.

Identity theft: Using another persons health


benefits card or identification to obtain products
or services or to impersonate that individual.

Together we can prevent it.


The overwhelming majority of customers, health
service providers and suppliers are honest and
ethical in their dealings with Saskatchewan Blue
Cross. Unfortunately, however, fraud sometimes
does occur. Every dollar of health care fraud
and plan abuse must ultimately be paid by
individual plan participants and plan sponsors,
which causes benefit plan costs to rise.

False billing: Claiming for products or


services not provided, performed or received.
Forgery or alteration of documentation:
Including, but not limited to, enrolment
information or claims information.

Saskatchewan Blue Cross has a policy of


zero tolerance toward any abuse of the benefit
plans we administer on behalf of our customers.
We actively investigate and pursue all suspected
fraudulent activities and have measures in place
to detect and combat fraud.

False claiming: Claiming for a more


expensive service than the service that
was actually provided.
If you suspect potential plan abuse or
improprieties (which may include fraud)
report it to us immediately.
Be cautious of co-payment waivers,
advertisements stating covered by insurance
or services claiming that they are covered by
insurance rather than based on need.
Think of your health benefits card as being as
valuable as a credit card. If lost or stolen, a
health care card could be used for identity theft
or to gain access to drugs and services that
may permanently appear on your medical
history or count toward your annual or
lifetime benefit maximums.
Closely examine the Explanation Of Benefits
(EOB) whenever you visit a health care provider
to ensure that all products or services billed to
you are the services you or a family member
received. If there is any question or discrepancy,
contact Saskatchewan Blue Cross immediately.

Double doctoring: Going from one prescriber to


another in order to obtain multiple prescriptions
for the same product.
Misrepresenting services: Performing uncovered
services but claiming for different services that
are covered.
Unbundling: Claiming separately for procedures
that are actually part of a single procedure.
Masquerading as health care professionals:
Delivering health care and/or health care
services without proper licenses.

These measures include:

Monitoring of claim patterns

Auditing to ensure compliance with


plan contracts and agreements

Pursuing civil and criminal prosecution


where evidence indicates fraudulent
activity has occurred

Restitution where warranted