Canadian Life & Health Insurance Facts // 2025 Edition 17
Working together to tackle fraud and keep health benefits affordable
Every year in Canada, health benefits fraud and abuse costs employers and insurers hundreds of
millions. False claims, fraudulent charges for non-covered services, plus the costs insurers bear
for investigations add up. That's why insurers are working together through CLHIA's Fraud = Fraud
program on initiatives to reduce benefits fraud and abuse and help to keep plans affordable.
The CLHIA has introduced three industry wide tools to mitigate benefits fraud–a central
registry of providers, a pool of anonymized claims data, and a framework for investigations
between insurers. These initiatives enhance insurers' own programs and produce results.
As of the end of 2024:
Education campaigns about how to
recognize benefits fraud and abuse
reached over 12M Canadians
Data from over 200 million claims was
analyzed using artificial intelligence
and generated over 13,000 alerts for
potential fraud
Over 500 alerts about potential fraud involving over
700 entities were recorded in our alert registry
Collaboration with insurers resulted in close to
40 joint investigations of suspected provider fraud
Health Insurance
L I N E S O F B U S I N E S S
