CLHIA-ACCAP

Canadian Life & Health Insurance Facts // 2026 Edition 17 Preventing fraud is a vital way to help keep benefit plans accessible, affordable and reliable for 27 million Canadians who depend on them. Fraud schemes are becoming increasingly sophisticated and organized. Common examples include false claims, billing for services that were never provided, and other forms of abuse. When fraud occurs, it can reduce the coverage available to Canadians, drive up premiums, and make health insurance plans less affordable for individuals, families, and employers. The CLHIA currently supports three collaborative tools that enhance insurers' own fraud detection programs. These tools include a shared registry of provider alerts, industry wide pooling of de-identified claims data to allow the identification of suspicious activity, and a framework for joint investigations between insurers. Anti-fraud program impact through 2025 How impact has grown since 2024 Shared registry of provider alerts Joint investigations between insurers De-identified claims data more alerts shared increase in joint investigations increase in actionable alerts Education campaigns about how to recognize benefits fraud and abuse reached more than 15 million Canadians and were seen over 18 million times. Over 750 alerts about potential fraud involving over 1000 entities were recorded in our alert registry. Data from over 205 million claims was analyzed using artificial intelligence and generated over 17,000 alerts for potential fraud. Collaboration with insurers resulted in over 100 joint investigations of suspected provider fraud. Health Insurance L I N E S O F B U S I N E S S Protecting health benefits through industry collaboration and an anti-fraud program 50% 150% 31%

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