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David Watterson, AVP, Healthcare Claims, Aviva Canada, shares the growing concern around treatment billing fraud, how technology is helping to detect it, and how Aviva is collaborating with industry stakeholders to find solutions to protect Canadians. Aviva Canada is the second largest property and casualty insurance group in the country, providing home, automobile, lifestyle, and business insurance to 2.4 million customers.
Équité: For Fraud Awareness Month, what type of insurance fraud would you like to raise awareness about and why?
- DW: Treatment billing fraud is a growing area of concern, and although it’s increasing, many Canadians are unfamiliar with how it can impact them. The majority of healthcare providers have their patients’ best interests in mind, but unfortunately, we are seeing more cases of customers falling victim to dishonest providers who will bill for services not rendered or additional treatment hours. These actions can deplete available benefit limits for the required treatment and can delay and impact a customer’s recovery.
Équité: How have fraud trends changed overtime?
- DW: Whether organized or opportunistic in nature, there are many factors that may contribute to evolving trends. For example, accident benefits fraud trends have evolved in sophistication with the implementation of data analytics that may help detect certain types of fraudulent billing.
Équité: What is your organization doing to protect your clients and the communities they live in from the impacts of insurance fraud?
- DW: Our concern is for our customers. It’s not fair for them to pay for those who commit insurance fraud.
At Aviva, we have dedicated teams to detect and take action against fraud, but also advise customers on steps to take if they suspect any fraudulent activity and offer a list of vetted treatment facilities part of our preferred provider network.
We also collaborate with industry stakeholders to find solutions to protect Canadians and to educate customers on how they can protect themselves.
Équité: How is technology influencing how you approach fraud detection?
- DW: Advanced technology is effective in helping us analyze data in real-time to detect potential fraud, by identifying things such as providers billing for more hours than would be typically possible in a day. Once we identify a potential scheme, we then work with the providers, and their respective colleges and regulators to investigate and ensure that their billing is accurate and fair to our customers.
Insurers are doing more than ever before to protect their customers, and by joining Équité Association, members have access to specific anti-fraud expertise designed to prevent and disrupt insurance crime. Fraud Prevention Month is an annual awareness campaign, which aims to educate Canadians on how to recognize and protect themselves from becoming a victim of fraud. Fraud always has a victim, and criminals typically target those who are the most vulnerable. In collaboration with Équité Association, our members are working to protect Canadians against insurance crimes, a top priority rooted in public safety.
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