Benefits Fraud – It’s a Fact

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Q: What happens when compensation monitoring goes awry?

A: Benefits fraud

B: Costly consequences

C: Negative public disclosure

D: All of the above and more

If this was a multiple choice question, the answer is D: All of the above and more.

A real-life example for this response comes from the Baycrest Centre in Toronto. In July 2019, the centre announced that 150 employees were terminated from the organization (resigned or let go) as a result of their participation in a long-term benefits fraud scheme. Allegedly, these health-care employees had defrauded their benefits plan of millions of dollars over the past eight years.

Click here to read about the allegations of benefits fraud at the Baycrest Centre.  

Unfortunately, benefits fraud is not something unique to one particular organization or sector. In 2016, the Toronto Transit Commission (TTC) hit the media headlines with a very similar and significant employee benefits fraud problem.

Click here to read about the TTC’s benefits fraud investigation.

In fact, the benefits industry continues to deal with increasingly creative approaches by employees who participate in fraudulent benefits activity resulting in losses of billions of dollars.

Click here to read about the impact of employee benefits fraud on the insurance industry.

As noted in the articles, benefits fraud is theft. It is stealing. It is exactly like taking money from someone else’s wallet without their express knowledge or permission.

Unlike other crimes, however, it is rare that perpetrators of benefits fraud are charged with a criminal offense. Until recently, it was also rare for employers to act on what was sometimes perceived as an act of ‘entitlement’ on the part of employees.  This perceived inaction on the part of employers does not come from a lack of interest or an act of conscious negligence. It may come from a lack of rigour in monitoring or systems controls which must be included as part of effective compensation management planning.

Not all employees steal from their employer. That is a fact. Some employees do steal from their employer. That is also a fact. Who pays for the consequences of stealing from their employer in the form of benefits fraud? We all do. That is the ultimate and most costly fact. Good compensation planning should take all of these facts into consideration, both positive and negative, in a proactive way so that the actual benefits of an organization’s benefits plan provide support and assistance for those who need it the most.

Discussion Questions:

  1. What types of monitoring systems or controls would you put into place as the Compensation Manager in these types of situations?
  2. The Baycrest and TTC articles state that this type of benefits fraud has been going on for years. How would you go about changing the organizational culture and a possible ‘entitlement’ approach in each organization?
  3. Is benefits fraud a ‘victimless’ crime? Explain your rationale

When Changes Keep Changing

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Imagine that you have lived with that ugly, out-of-date bathroom in your house for the past 20 years.

The eyesore tiling from the ‘80s is chipped, the toilet overflows from time to time, and the bathtub drains keep clogging. So, you finally pull the plug, get your finances together, and hire a contractor to renovate it.

It eventually gets done. The new bathroom looks a lot better, although a few things did not get finished and the cost was much more than you had anticipated. Granted, it is finally an improvement from what you had before. Suddenly, the contractor you hired to do the work is replaced with a new contractor who tells you that the bulk of the completed work is wrong. The new contractor begins to rip out items that were just installed. The new contractor tells you that you have to re-renovate the bathroom by finding and putting back many of the broken items that you were happy to have removed. Also, the things that you had planned to keep working on to continue the bathroom improvements are just not going to happen. Of course, you have to pay for it all over again. Throughout all of this you realize you have no choice other than to keep trying to figure out what and how to proceed because it is the only bathroom you’ve got.

This little analogy can be applied to what has happened in Ontario as a result of the continuing changes to the provincial Employment Standards Act. Under the previous government, Bill 148 began to be implemented in January 2018. The changes under this bill were significant, given that no amendments had been made for over twenty years. The primary impact included ongoing increases to the minimum wage, scheduling, vacation and holiday pay changes, along with other amendments impacting compensation plans across the province. A new government was voted in and introduced Bill 47 for immediate implementation. By January of 2019, Bill 47 had repealed and/or replaced many of the aforementioned changes, some of which included the requirement for employers to revert back to pre-Bill 148 practices.

Click here to read a summary of the changes from Canadian HR Reporter.

Click here to refer to the updated guide to the Employment Standards Act.

While there are many opinions on whether or not the impact of Bill 47 is good for employees or employers or both or none, the bottom line is that HR practitioners across the province have had to deal with all of it. Anecdotally, it has not been a smooth transition. An HR colleague, who works in compensation and didn’t want to be named, described her departments’ reaction as follows: “We were in shock. I could feel myself shaking when the new changes were announced. We had absolutely no idea what we were supposed to do. What would happen to our employees and their wages? What would happen to all of the work and changes we needed to put into place over the past year? It was all gone. We had to start all over again. Trying to figure out what was new and what we had redo has been a nightmare.”

As she turned away, she left with saying how lucky she was to work with a team of HR professionals because they would get it done.

Perhaps, upon reflection, all of this represents the challenge and the opportunity of working in Human Resources. No matter what happens on the political, legal and implementation landscape, sometimes our job is simply put – just get it done.

Discussion Questions:

  1. How will you work through implementing changes that you may or may not agree with on behalf of your employer as an HR professional?
  2. Review the changes to the Employment Standards Act and identify three areas that have a direct impact on compensation planning.
  3. How will you calculate wage increases (including minimum wages) for the next five years?