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Fraud

While ASEBP strives to protect you all year-round, benefits fraud continues to impact all of us and has serious consequences. The best way to prevent benefits fraud and protect your benefit plan is to report suspicious activities. If you notice anything suspicious in your claims history or witness or know of any benefit plan fraud, report it now: 

What is Benefits Fraud? 

Benefits fraud is the intentional abuse, misuse or overuse of the benefit plan for personal gain by service providers or covered members. This is unlawful and affects everyone. It has lasting impacts, including higher premiums, suspension of benefit coverage or worse. Benefits fraud examples: 

  • Transferring coverage between covered family members (e.g., claiming a service under a dependant’s benefit coverage when the service was for you) 
  • Accepting incentives or gifts from providers in exchange for submitting claims (e.g., getting a free pair of shoes or a purse with foot orthotics) 
  • Claiming benefits that are not covered by the plan as an eligible benefit (e.g., receiving a spa treatment and claiming it as a therapeutic massage) 
  • Providers claiming for products or services that were not provided 
  • Misrepresentation of conditions in a disability claim 

Our Approach

01ASEBP's Approach

ASEBP is committed to promoting, protecting, improving, and sustaining the health of covered members and their dependants. Working to identify and prevent benefits fraud helps ensure the financial sustainability of the plan.  

Using robust systems, large amounts of data can be analyzed at any given time. This information is routinely reviewed to ensure claims accuracy, and ASEBP has implemented measures to detect unusual claiming patterns that could be related to benefits fraud.  

The Benefit Assurance team monitors and analyzes information, conducts audits and reviews on claims, and determines the most suitable action against cases of fraud. 

02Providers Tool and Ineligible Providers Tool

Service Providers Tool  

When using the Service Providers tool, service providers shown are in Alberta and only providers who have had claims processed by ASEBP in the last 6 months are visible. This feature is for informational purposes only as the ASEBP covered members provider recommendations are populated in the Service Provider tool.   

Inelligible (delisted) Providers Tool  

An ineligible providers tool is available on My ASEBP  the Mobile App to help covered members make informed decisions when seeking providers within Alberta. The list contains providers ASEBP will not accept claims from due to non-compliance with claiming standards – ASEBP will not reimburse for services or products provided by them. 

03Know what to look for when choosing a service provider

Choose service providers carefully by  

  1. Check ASEBP’s list of Ineligible Providers (delisted providers list) found on My ASEBP
  2. Check service provider details and credentials.  
  3. When in doubt, contact an ASEBP benefit specialist:  

How to Keep your Benefits Safe 

  • Do not accept incentives 
    Cash, gift cards, or material items from service providers can be warning signs of benefits fraud. Only purchase products or services that are medically necessary.  
  • Never sign blank claim forms 
    Only sign claim forms once you have confirmed they are complete and accurate.  
  • Always request and review receipt information along with your Explanation of Benefits 
    Whether you are submitting a claim for reimbursement or a claim is direct billed, always ask for a copy of your receipt and review the information for accuracy. When claims are direct billed, ask for a copy of your Explanation of Benefits. This will provide you with your claim details. If you notice any discrepancies, be sure to have your provider contact the Provider Services department to correct the claims information.   
  • Protect personal information 
    Only share ASEBP ID and personal information with your service providers and ASEBP benefit specialists.  
  • Review claims history 
    Regularly check your claims online on My ASEBP or on the Mobile App to make sure claim details are correct.  

Covered members, and members of the public, have access to anonymous reporting tools to help report fraud, including a confidential hotline and email.   

As a trusted partner, ASEBP’s goal is to ensure the continued viability of the Plan to continue to support your, and your family’s, health needs.   

For more information about benefits fraud, visit the Canadian Life and Health Insurance Association.