How is benefits Fraud detected and what can OSSTF Benefits plan members do to help?

October 2, 2025

Answer:

How are fraudulent claims identified?

ALL submitted claims go through advanced analytics to identify potentially fraudulent activity.

The staff and systems utilized for the claims handling of the OSSTF Benefits Plan are constantly being monitored with various detection tools including:

• Fraud recognition training
• Advanced data analytics
• System controls
• Drug management
• Specialized staff

Detecting benefits fraud

Benefits fraud is not always easy to spot, especially when it is suggested by a service provider you trust. Look for these warning signs and report them if they occur:

• Feeling pressured by your health or dental service provider to get unnecessary products or procedures
• Being encouraged to claim products or services that you didn’t receive, or are not covered by your plan
• Health or dental service providers who seem more concerned with the details of your insurance coverage than providing the right product or service
• Feeling encouraged to include incorrect or misleading information on a claim
• Being asked to sign a blank claim form (often completed later with misleading information)
• Health or dental service providers who use your plan membership information to charge for products and services you never received
• Being offered cash or other incentives in exchange for your policy information

How can plan members help to protect the OSSTF Benefit Plans from fraud?

Understanding how to use the benefit plans appropriately can help members guard against potential fraud. Here’s how:

• Members should familiarize themselves with their benefits plan and the limits on various types of coverage.
• Members should always keep their personal benefits plan access information in a safe place and not lend their card to anyone.
• Members should always check their claim explanation of benefits and receipts to make sure they reflect the services they actually received.
• Members should view list of providers not covered under the Wellness Centre in My Claims
• Members should be able to understand the treatments, services and products being prescribed and when they don’t not be afraid to ask questions!

What if a member suspects fraud?
If a member suspects that someone they know or a service provider may be committing fraud, they can confidentially report it to comments@osstfbenefits.ca, or Manulife (in care of
OTIP) at 1-877-481-9171 or gb_investigative_services@manulife.com.

 

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The information in this document is provided by OSSTF Benefits for general information only. OSSTF Benefits endeavours to have all information current and accurate. We make no representations or warranties of any kind, express or implied, about the completeness, accuracy, reliability, or suitability of the information included. All information is subject to change without notice.

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