Track: Anti-Fraud

Provider fraud continues to evolve in scale and sophistication, requiring insurers to move faster—and together—to stay ahead. This session offers an inside look at Project Inverness, a complex provider fraud scheme that escalated rapidly and ultimately brought the Joint Provider Fraud Investigation Program (JPFIP) for consideration. 

Manulife will walk participants through how the scheme was first identified, highlighting the key fraud indicators involved, including fake clinics, false policies, and coordinated activity that grew exponentially over time. Attendees will gain insight into how early red flags developed into a large‑scale investigation and the decision points that led to broader industry collaboration. 

Leila Campbell from CLHIA will then share how leveraging the JPFIP framework proved critical in disrupting the scheme, enabling participating insurers to get ahead of the fraudsters through information sharing, coordination, and collective action. 

The session will conclude with insights from insurers who participated in the joint investigation, offering practical perspectives on collaboration, challenges encountered, and lessons learned that can be applied to future provider fraud threats.