Fraud and vigilance

We take fraud very seriously. Please contact us if you notice any suspicious activity on your membership.

A man in his home office

Proudly not-for-profit since 1951.

We turn 70 at the beginning of 2021. Seventy years of providing the highest value health insurance will teach you a thing or two about health and loyalty. We are proud to say that after 70 years, we still exist to bring you value every day. Simply put; our loyalty is to you and your health is our priority.

Preventing fraud

Fraud impacts us all. Every case of fraudulent claiming contributes to costs, which can then lead to higher premiums. We have a zero-tolerance policy for inappropriate claiming. Insurance fraud is a serious criminal offence.

Our investigations team identifies fraud and prosecutes offenders. Read our recent article about two successful fraud prosecutions.

Examples of fraud

Insurance fraud can originate in a provider’s office, from the people covered by a membership or from the health fund.

Examples of insurance fraud include:

  • Inaccurate recording or claiming of treatments and services.
  • An agreement between a member and a provider to claim fraudulently.
  • Claiming for services or treatments that were not provided.
  • Altered receipts or falsifying documents.
  • Allowing a non-member to use your CBHS membership card.

How to reduce the risk of fraud

There are steps that you can take to reduce the risk of fraud and inappropriate claims.

  • Keep your CBHS membership card secure and never leave it with a provider. Treat your membership card as you would a credit card.
  • Carefully review accounts and receipts before signing the paperwork.
  • Report your lost, stolen or misplaced membership card to us immediately.
  • The people named should be the ones who received the service or treatment.
  • The number of services should be correct.
  • The name of the provider should be the same as the provider who carried out the treatment or service.
  • There should not be any benefits paid for quotes or for services that were not provided.

You should also periodically review your claims history in the Member Centre on our website. This shows benefits paid to you, and to providers on your behalf, using your membership card. (Please check the ‘Include provider remittances’ option to include payments to providers). This section also shows admissions to hospital and medical treatment. Contact us immediately if you notice any errors.

Member fraud

Our zero-tolerance policy for inappropriate claiming extends to members who knowingly attempt to defraud the fund by submitting false claims or colluding with providers to submit false claims.

For the benefit of other members, our fund rules allow us to terminate the membership of any member who behaves in this way.

Inform us of fraud

If you suspect someone is making fraudulent claims or if you have any queries about inappropriate claiming, contact us immediately. You should also let us know if there are errors on your claim history report on our website.