What is Health and Dental Benefits Fraud?

October 2, 2025

Answer:

Benefits fraud occurs when a member intentionally submits false or misleading information for the purposes of financial gain, and it can take on many forms, including:

• Billing for health or dental benefits that were not received
• Billing inflated costs for eligible expenses that were higher than actually paid to the benefits provider

• Fraud may also be committed by service providers. Claims from providers that are deemed by Manulife to be fraudulent will not be approved. Manulife maintains a list of providers not covered. How to view this list:

1.After logging in to My Member Account, click on your Group Benefits plan.

2.Click Check my claims status or history under My claims.

3.Click Information & Assistance.

4.Under Guides, click Providers Not Covered.

Members can also call OTIP Benefits Services at 1 866 783 6847 to inquire about these providers. We encourage you to check this list periodically to minimize delays to your claims.

Benefits fraud affects us all. You might think that benefits fraud is just stealing from Manulife, our benefits claims payor but in fact, the fraud is against the OSSTF ELHT. The OSSTF Benefits Plan provides meaningful life, health and dental benefits to you and your family members. We want this plan to continue to be available to you and your family members for years to come. False health and dental claims can put the OSSTF ELHT benefits at risk for all OSSTF members. They increase the costs of the plan, which can result in a reduction to the benefit levels and/or higher member contributions towards the benefits.

• It is important to understand that whether these fraudulent claims are submitted because a member may need extra money or want more treatments than the plan covers, the submission of these claims is fraudulent. The OSSTF ELHT Board of Trustees must take action to protect the long-term sustainability of the plan.

 

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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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