Suspicious activity

Below are some examples of suspicious claiming we would assess / investigate:

• Intentionally fabricating or altering invoices and receipts
• Submitting claims for treatment that differs from what was provided
• Billing for treatment that was not provided

How can members help?

• Never sign a blank claims form and leave it with anyone – even a healthcare provider
• Carefully check the details on invoices and your Claim Update to ensure they match the treatment received and costs paid
• Don't be afraid to ask questions, report issues and query invoices if you see anything suspicious in your claims history

How can providers help?

• Ensure staff are properly trained to submit prior approval and claims
• Ensure Eligibility Criteria are met prior to submitting an application or claim
• Ensure any ACC claims are submitted to ACC
• Tell us about any refund or discounts that have happened from the original claim
• Ensure you are using the correct and accurate information (e.g. date and items/codes/procedure codes) on every claim
• Do not share your password and remember you are responsible for claims using your provider login
• Let us know if you are feeling pressured to make a claim

Our approach

We take all matters reported seriously. We will conduct a confidential assessment and/or investigation of the report. Depending on the investigation’s outcome, the matter may be referred to appropriate third parties, and efforts may be made to recover any losses.

If you would like to report suspicious activity, please refer to our Whistleblowing page  or complete our Suspicious Activity Form.

Southern Cross Medical Care Society (trading as Southern Cross Health Society) is a licensed insurer and a licensed financial advice provider. For more information about the financial advice service we provide and a copy of our public disclosure statement please visit southerncross.co.nz/disclosure-statement.

Southern Cross Medical Care Society (trading as Southern Cross Health Society) has an A+ (Strong) financial strength rating given by Standard & Poor’s (Australia) Pty Limited. The rating scale is: AAA (Extremely Strong), AA (Very Strong), A (Strong), BBB (Good), BB (Marginal), B (Weak), CCC (Very Weak), CC (Extremely Weak), SD or D (Selective Default or Default). Ratings from ‘AA’ to ‘CCC’ may be modified by the addition of a plus (+) or minus (-) sign to show relative standing within the major rating categories. Full details of the rating scale are available at www.spglobal.com/ratings/en/about/intro-to-credit-ratings. Standard & Poor’s is an approved rating agency under the Insurance (Prudential Supervision) Act 2010.