Employee lies about daughter, cashes her benefit cheques

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The Ontario Superior Court of Justice recently ruled that Costco had the right to fire long-term employee Mykki Cavic for cause after she submitted claims to the company-sponsored health insurance plan for a daughter that didn't exist and cashed the reimbursement cheques.

At the time of her firing, Cavic had worked for Costco in various positions for 19 years. She was a first line manager responsible for supervising 20 to 25 employees, earning $65,000/year plus employee benefits. All benefit premiums were paid for by her employer.

Read: What healthcare fraud looks like

Costco self-insures the company benefits but a Canadian insurance provider administered the program and reimbursed employees for 80% of approved claims. A new flexible benefits plan was introduced by Costco on July 1, 2010.

Cavic testified that since 2004, a "phantom" dependant named Sarah-Eve Dore was mistakenly listed on her benefits profile. She notified the provider on several occasions but the error still was not rectified by 2010. In order to get the provider's attention regarding this situation, she decided to falsify documents and submit claims in the name of Dore, totalling $170.

Read: Protect your clients' benefits plans from fraud

The claims were approved at first, but the provider subsequently called Cavic to verify Dore's status. She did not take the opportunity to request that Dore be removed from her benefits profile. In fact, she confirmed that Dore was her daughter. Her actions were neither consistent nor logical in light of the alleged reasons for falsification of the documents in her testimony.

Costco's theory was that by submitting certain paramedical expenses in the name of her dependants rather than in her name, Cavic was trying to obtain reimbursement for an amount greater than the prorated amount of paramedical coverage ($200 instead of $400) available in the six month transition period before the flex plan was implemented on July 1, 2010.

Cavic also submitted another falsified document in the name of her son actual Nicholas for treatment she received on August 9, 2010. She said this was an honest mistake because she thought she was entitled to allocate flex dollars interchangeably between her and her family members.

Read: 9 fraud prevention tips for benefit plan members

The judge did not find Cavic's explanations credible in regards to the false claims for either her fake daughter or her son. He dismissed her claims for both wrongful dismissal and damages under the Ontario Human Rights Act with court costs payable by her to her former employer.

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