Fact: If Unchecked, Fraud Will Collapse The Country’s Vaunted Healthcare System In Just A Few Years
Part 1. Canada’s Health System Is Out Of Control
The Canadian Institute for Health Information (CIHI) reports Canada’s health care industry takes in an estimated $242 billion annually or just over $6,600 for every man, woman and child.
Canada’s healthcare spend is roughly the size of Finland’s entire economy, per the World Bank. It is more massive than the economies of Portugal, Greece, and New Zealand, and it dwarfs the gross domestic product of 146 additional countries.
But since most people can’t really get a grasp on what one billion is, let alone hundreds of billions, let’s put it this way:
- Canada’s healthcare spend is a staggering $27.6 million per hour or $460,426 every minute of every day – 24/7, around the clock.
It is more money than any other area of the economy and dominates the country’s budgets every year.
It is getting worse
The cost is growing exponentially. The 2017 estimated cost is up from 2016 by almost $200 per person. In the year 2000, Canada’s health care spend was roughly half of what it presently is, so it has more than doubled in record time — it is, in fact, a 142 per cent increase over the course of 18 short years.
The most significant percentage cost growth has been for drugs which now account for 16.4% of the healthcare spend. That’s $39.7 billion (with a “b”), or $1,086 per person. This represents a 4.2% cost increase, double Canada’s annual inflation rate for 2017.
How much is stolen
How much of this cost is due to needless or even fraudulently prescribing or dispensing? A lot, according to Karen Voin of the Canadian Life and Health Insurance Association. She estimates that between 2 and 10 percent of healthcare dollars are lost to fraud.
So, let’s take the average of 6%. That means that we are losing $2.4 billion (again, with a “b”) every year to – and let’s call it what it is – the criminal element.
In Ontario alone, it works out to $118 million lost each year. And what does the Ontario Ministry of Health and Long-Term Care do about it? Almost nothing, sad to say. The Ministry recovers only a small portion of it. Bonnie Lysyk, the Auditor General, puts the number at a measly $5 million, or about 4.2% of what was stolen from us.
Your government doesn’t care
And even when the Province can be bothered to put on a show of looking for fraud, they don’t tell the police! The Auditor General’s office revealed that for the years 2013-14 and 2014-15, the Ministry reported zero (0) suspected fraud cases to the OPP. In 2015-16, the Ministry reported two cases.
We don’t just mean little or no suspected prescription drug related fraud cases were reported by the Ministry – we mean that little or no suspected healthcare fraud of any description was reported.
In August 2016, the Ontario Provincial Police (OPP) Anti-Rackets Health Fraud Investigation Unit had to take matters in their own hands and approach the Ministry to ask why they weren’t sending any files for investigation. (Perhaps the OPP should be investigating the Ministry.)
These are significant facts
And the most astounding fact of all is that no one is minding the shop. Not one health minister. Not one premier. And certainly not the Prime Minister of Canada.
Don’t believe us? Just call Canada’s Minister of Health’s office at 613-957-0200 and ask. You will be astounded. There is not a single agency that even cares what happens with the $662 million they give the provinces every single day!
Could this unconscionable negligence be the reason that Canada’s healthcare fraud is out of control? Because it is. In fact, it is so out of control it is threatening to bankrupt the country.
This is one of a 10-part series. Stay tuned for Part 2, coming soon!
Tim Daciuk says
It is always amusing to read how facts can be twisted and misinterpreted. Canada spends more on healthcare than the economy of Finland! So what? Canada spends more on healthcare than the economy of Swaziland and Togo combined. Finland has a smaller economy; it also has about 17% of the population. And in any measure of healthcare quality (see for example the Legatum Institute’s health sub-index) Finland does not show up.
So do we really spend a fortune on healthcare? According to this article, complete with dizzying statistics, we do. However, both the US and Norway spend more and do not make the list of top countries for healthcare quality. In fact, and facts are important, Canada’s spending is actually 5th or 6th in the world, depending upon the measure you use.
Spending on healthcare is increasing. Spending on everything is increasing/ The spending increases are not exponential; you need to figure out what exponential growth is. Spending increases are linear at best.
Healthcare fraud is a problem. It is a worldwide problem so focusing on Canada out of context is just silly. Healthcare fraud is estimate to be 260 billion (of reporting countries) according to the Global Healthcare Anti-Fraud Network. At 2.4 billion, when put in context, we are not doing too badly.
Scaremongering material such as this is designed with some agenda in mind. I am sure that in the next few releases we will see what the hidden agenda of this group really is, but, let’s be sure, it is not to do anything other than to support their own political or financial ambitions.
John Lyons says
I think citing losses between 2 and 10% tells the tale. People bantering this figure don’t really know and have no idea on how to measure it. They simply pass on hyperbole bantered about for over 20 years. A Standing Committee of Congress study fraud to the US Medicaid and Medicare systems said as much circa 1993. Besides, it’s situational. Malcolm Sparrow (Harvard) chronicles in a “Licence to Steal”, several situational examples of fraud at much higher rates…but this does not mean everywhere.
Fraud attacks to health care systems is insidious. It can go on for years undetected. So, it’s not what we know, it’s what we don’t know that is important. Pundits are also not mindful in separating basically honest providers cheating a little bit when tempted to do bad things, from predatory attacks including those from organized crime groups. The interventions for both are not the same.
The international standard for fraud controls endorsed by the Chartered Professional Accountants of Canada, and which emerged from Sarbannes-Oxley (SOX) in the wake of the Enron, Tyco and WorldCom debacles recommends organizations establish a body directly reporting to the Board of Directors – over the head of the CEO – to protect shareholders. This would equate in health care to a corruption and fraud controls body directly reporting to the Deputy Minister – to protect taxpayers.
Ask the MOHLTC why their misuse, abuse and fraud policy is not posted to their website? Ask them if they have guidelines for the program areas to follow? Listen to their answer carefully. Be prepared for them to obfuscate, because they don’t have any.
R. Kelly says
I am not shocked by the articles claims… and even less so by the comment from Tim Daciuk. An opinion which is shared by most Canadians.
THAT is the problem .