University acts against eight employees over fraudulent benefits claims

“The university thoroughly investigates suspected cases and works with the insurer in these matters to seek repayment of claims and refers suspected cases to police,” the university said, but details regarding what kind of specific actions were taken were not publicly disclosed.

There is also no word if any more employees are being investigated by the university, or if criminal charges were laid against the eight.

Sources told CityNews that the employees affected work in at least two departments – housing services and parking services. The anonymous sources also mentioned that in one of the cases, the fraud was related to a fake orthodontics claim, and that one of the employees is no longer with the school.

CityNews reached out to employment lawyer Jon Pinkus for commentary on the development, explaining that it is usually the benefits provider that alerts the employer/plan sponsor of any irregularities or possible fraud.

“They’re going to be undertaking an investigation, and that will notify the employer of some irregularities, some potential fraud. They’ll undertake an internal investigation and report to the employer,” the lawyer said.

“And if it turns out that the employee or employees have been involved in this fraud, almost invariably those employees or employee is terminated.”

According to the Canadian Life and Health Insurance Association (CLHIA), both employers and insurers have lost millions of dollars each year due to fraudulent group health benefits claims.