Protecting your Plan

How you can help protect your plan

Fraud can lead to higher insurance premiums and/or reduced coverage for you. As a Plan Member you can play a role in helping to prevent fraud by:

• Safeguarding your benefits information and RWAM OneCard to prevent unauthorized use
• Understanding what claims a Health Care Provider is submitting on your behalf
• Ensuring that the services you received reconcile with those billed (e.g. date, provider, duration and type of service) and that the Claim Statement/Explanation of Benefits reflects the same

If you have any reason to suspect insurance fraud is taking place by either a Health Care Provider or a co-worker, contact the RWAM Special Investigations Unit: 

• by email  special.investigations@rwam.com
• by phone 1-888-742-7926 ext. 4807

Fraud can also be reported to insurers via the Canadian Life and Health Insurance Association website.

What RWAM does to protect your plan

RWAM is committed to ensuring that your Group Benefit Plan operates within the guidelines of your contract and according to industry parameters. Fraud can present itself in numerous ways. The following are some of the measures used to protect your plan:

• Conduct provider and patient audits to confirm services being claimed have actually been rendered as billed by the provider indicated on the receipts, and received and paid for by the insured
• Investigate suspicious claims or patterns (e.g. over-utilization or unusual claims frequency) and follow up requesting additional information to support the claim or validate the pattern
• Check credentials of paramedical providers to ensure they are active, current members with the appropriate regulatory authority and/or association, and are billing appropriately