$600K health care benefits scam: 'Mastermind' arrested after alleged Ont. operation involving 300 people

Peel Regional Police have arrested and charged a 30-year-old Vaughan, Ont., resident, who they claim was the “mastermind” behind a "health care benefits scam," which took place over a 22-month period.

The scam allegedly involved approximately 300 people working as part of a large online retailer, with 30 people being the “most complicit,” said Tyler Bell, a Peel police spokesperson, to Yahoo Canada. After an investigation by the Fraud Bureau, Anand Pareshkumar Amin was arrested and charged in connection to the operation.

“The majority of the individuals were newcomers [to Canada] with limited understanding of how benefits work,” said Bell. “The mastermind behind this essentially convinced people that they were entitled to benefits and to provide him with their access information where he made fraudulent claims on their behalf.”

The investigation began after officials were contacted by a health care benefits provider, who had completed their own fraud investigation and determined that there was criminality involved.

Once the payout was dispersed by the health care benefits provider, the illegally obtained funds would then allegedly be shared between the individual plan member and Amin, who also worked for the online retailer.

The criminal investigation concluded that this fraudulent operation ultimately resulted in an initial loss of over $600,000 for the health care benefits provider, over the course of almost two years. Bell said that some of the money has been restituted, and the total loss in the end is approximately $100,000.

Given that the company received repayment from most involved, combined with the circumstances with many of them being newcomers to Canada, the only individual charged is Amin, said Bell.

Amin has been charged with fraud over $5,000. He was released with conditions and will appear at the Ontario Court of Justice in Brampton, Ont., on Sept. 25, 2023.

Officials are urging anyone with information regarding this investigation to contact the Peel Regional Police Fraud Bureau at 905-453-2121 ext. 3335. Tips can also be submitted anonymously to Crime Stoppers at 1-800-222-8477 (TIPS) or www.peelcrimestoppers.ca.

Peel police did not disclose the name of the health care benefits provider or the name of the large online retailer.

Health care benefits fraud: How to protect yourself

To ensure that you always protect yourself from the consequences of health care benefits fraud, learn how to properly use your benefits and how to properly recognize benefits scams.

Health care benefits fraud occurs when you intentionally submit false or misleading information to your insurance provider for the purpose of financial gain. It can be committed by health or dental service providers, plan members or both.

Peel Regional Police Officials have shared some tips that can help you prevent and identify benefits fraud:

• Protect your personal information, which includes your benefits plan username, password and other access information

• Never share your information for others to obtain products or services

• Check your receipts to ensure the accuracy of services or treatment received

• Never sign your name on blank forms

• Depending on your provider’s policy, keep a copy of the original receipt to support your claim

• Report any suspected abuse or fraud to your insurance company

If you suspect that your health care service provider, coworkers or others you know are encouraging you to submit a fraudulent claim, or something doesn’t feel right, report it to your employer or insurance provider.

Committing or participating in benefits fraud could result in serious consequences, such as losing your job, benefits and being charged with a crime.

Peel Regional Police is encouraging the community to learn more about these and other trends currently affecting Canadians by visiting the Canadian Anti-Fraud Centre and the Peel Regional Police Website.