Fraud prevention
Fraud awareness
We are committed to protecting you and the integrity of Defence Health. Part of this commitment is to discourage fraudulent behaviour by ensuring that controls are in place to minimise the possibility of fraudulent claims being paid. We actively monitor claims; regularly conduct member and provider audits, and investigate any concerns regarding member or provider behaviour brought to our attention.
What is fraud?
Fraud is the intentional act of deceiving or misrepresenting information. Health insurance fraud typically results in ineligible benefits being paid.
Fraud is a crime and persons involved in such activity can be prosecuted.
Who commits fraud?
Fraud might be committed by a member, a provider or an employee.
Some examples of fraud by a member includes concealing pre-existing conditions, ineligible members and/or dependants, or failure to disclose claims that are the result of a work related injury.
Provider fraud includes billing for services not provided, billing for a higher level of service than was provided, altering invoices, or providing unnecessary services.
How to protect you and your premiums
You can protect yourself by:
- Notifying us immediately if your card has been lost or stolen
- Verifying benefit statements you receive from us. Check that all services were received on the dates provided
- Validating all electronic invoices received when using your membership card prior to authorising payment. Ensure that all services were received
- Treating your Defence Health membership card like your credit card. Do not leave your card with your provider, and
- Allowing only persons named on your membership card to use the card.
Notify Defence Health of suspected fraud
Notify Defence Health as soon as you suspect health insurance fraud:
Information received will be managed in accordance with Defence Health's Privacy Policy. You can remain anonymous.
Preventing and detecting fraud helps to contain premium costs that saves you and every other member money.
Fraud prevention
Fraud awareness
We are committed to protecting you and the integrity of Defence Health. Part of this commitment is to discourage fraudulent behaviour by ensuring that controls are in place to minimise the possibility of fraudulent claims being paid. We actively monitor claims; regularly conduct member and provider audits, and investigate any concerns regarding member or provider behaviour brought to our attention.
What is fraud?
Fraud is the intentional act of deceiving or misrepresenting information. Health insurance fraud typically results in ineligible benefits being paid.
Fraud is a crime and persons involved in such activity can be prosecuted.
Who commits fraud?
Fraud might be committed by a member, a provider or an employee.
Some examples of fraud by a member includes concealing pre-existing conditions, ineligible members and/or dependants, or failure to disclose claims that are the result of a work related injury.
Provider fraud includes billing for services not provided, billing for a higher level of service than was provided, altering invoices, or providing unnecessary services.
How to protect you and your premiums
You can protect yourself by:
- Notifying us immediately if your card has been lost or stolen
- Verifying benefit statements you receive from us. Check that all services were received on the dates provided
- Validating all electronic invoices received when using your membership card prior to authorising payment. Ensure that all services were received
- Treating your Defence Health membership card like your credit card. Do not leave your card with your provider, and
- Allowing only persons named on your membership card to use the card.
Notify Defence Health of suspected fraud
Notify Defence Health as soon as you suspect health insurance fraud:
Information received will be managed in accordance with Defence Health's Privacy Policy. You can remain anonymous.
Preventing and detecting fraud helps to contain premium costs that saves you and every other member money.