Suspected fraud identified

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Background

Sun Life’s Investigative Services Unit has informed us that eight health care clinics/facilities service providers located in Brampton, Mississauga and Toronto, Ontario are allegedly committing fraud. At this time, we are aware that the suspected fraud impacts some of our plan sponsors and some of their plan members.

One suspect has allegedly been convincing some plan members to assign the payment of services to him or to his clinics/facilities. These unauthorized assignments mean that some plan members are not being reimbursed for services they received from these facilities. In other instances, we believe that the individual and his staff have obtained sufficient personal information of their clients and are filing false claims in their plan members’ names and directing payment to the facilities or to themselves.

Does it affect you or your plan members?

If you have not already been specifically contacted by our Investigative Services Unit about whether this alleged fraud impacts you or your plan members, then it has not been found to be affecting your organization at present.

What we’re doing about it

Sun Life has a strict zero tolerance policy for fraud. We are committed to protecting our clients from all health care fraud and abuse.
Our Investigative Services Unit and law enforcement are actively investigating these activities. They are also working with those plan members who have been identified as being impacted.

As a result, Sun Life will not reimburse plan members for any services they receive on or after August 8, 2011 that are provided by any of the following eight facilities:

  • Sarwarmed Medical and Health Clinic (Brampton)
  • Conestoga Foot Clinic Inc. (Brampton)
  • Dynamic Footcare & Therapy Inc./Happy Feet are Healthy Feet! (Brampton)
  • Malton Foot and Ortho Clinic (Mississauga)
  • Gore Health Centre (Brampton)
  • Dynamic Optical (Brampton)
  • Woodbine Foot and Orthotics Clinic Inc. (Toronto)
  • Castlemore Optical Inc. (Brampton)

Plan member communication

We have provided some suggested messaging for you to distribute to your plan members to inform them about this alleged fraud and about the August 8, 2011 deadline noted above in the event that they plan to use any of the above-referenced health care facilities. It is important that your plan members are aware of this matter.

Next steps

Sun Life’s Investigative Services Unit continues to investigate these activities in more depth. We will provide further information to you about the alleged fraud as it becomes available to us. We thank you for your patience and understanding.

Questions?

Please contact your Client Service Administrator at 1-877-786-7227.