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Bringing about a higher level of transparency and accountability in provincial and federal governments to help protect taxpayers from abuse

Bringing about a higher level of transparency and accountability in provincial and federal governments to help protect taxpayers from abuse.

Can a gadget save you from the distraction of gadgets?

Most people I know are, to some degree, addicted to their cellphone. We’ve all felt it. How an illuminated screen demands every ounce of your attention. How an unexpected text message evokes a physiological response like an amphetamine. And then there’s that seemingly insatiable impulse to check the time, check the weather, then check the time again. It’s gotten to the point that much, if not most, of the time I spend on my phone is in a state of distraction, not productivity. I’d bet you’re in the same boat.

Read more at digitaltrends.com

10 Shocking Facts About Canada’s Healthcare System – Part 7.

Part 7. Fraud Is Simple To Detect, Inexpensive To Find

Every credit card company has ways to detect potential fraudulent activity and they take simple steps to verify the validity of suspect charges.  For instance, if they see a charge on a credit card that is atypical such as large purchases made just after small ones (which is, apparently, behaviour characteristic of a criminal with a stolen card) or a large number of online purchases or purchases that don’t fit a cardholder’s profile, they will telephone the cardholder to ask if he or she  authorized the purchase. And why? Because credit card companies are intensely interested in stemming the losses they incur from fraudulent transactions.

Banks monitor for fraud all the time, and for the same reason.  They use fraud detection indicators to identify anomalies such as unusually high purchases of popular items, they flag multiple accounts opened within a short period of time, they monitor usage patterns.  They use readily available software that analyzes data and generates alerts.

Private insurance companies employ a variety of methods, both electronic and good old-fashioned “have a look”, to detect and discourage fraud.  They employ pre-payment investigation of flagged claims, they employ forensic accountants, they monitor specific healthcare providers. They have instituted co-pays and deductibles, not just for the cost-saving component but also to give the patient incentive to refuse unnecessary treatment.  Some areas of benefit particularly susceptible to fraud and abuse now have annual or even lifetime caps. Some insurance companies limit the quantity of medical accessories that they will cover.

There are software companies, service providers and many other types of business who specialize in providing fraud detection services.  And some of them are very, very good at what they do.

When it comes to the government, not only do they have the budget to do this, they also have the means already in hand.  

And what does the Ministry of Health and Long-Term Care do to stem the drain of tax dollars stolen by fraud?  They’ve set up an email address and a hotline for “the public” to report suspected cases of health card abuse.  Please.

How much time or effort would it take the Ministries of Health to do something effective in combating fraud?  Take for example the Ontario Health Insurance Plan or OHIP. The Ministry does send letters to patients asking them to verify that they did receive the services that were billed for.  This is not a very effective strategy, though, as the response rate from the patients is less than 2%. Instead, how about requiring that a patient sign a form after treatment verifying that the treatment and services being billed for were in fact received?  Granted, that would be a nuisance for all concerned but it would make it very difficult for anyone to bill for goods and services not delivered.

Every doctor who bills OHIP has a profile in the system.  Well it doesn’t take more than a single report to determine which of these are billing outside of the typical profile.  So if you have, say, 1000 of a particular type of specialist in the system billing an average of $400,000 annually, the few that are billing several times that should be easily detected and flagged for investigation.  The ophthalmologist who billed $6.6 million in one year springs to mind as do the 154 diagnostic radiologist who each billed OHIP $1 million or more.

Even the Ontario Minister of Health and Long-Term Care recognizes that something is wrong.  Eric Hoskins was quoted in the Toronto Star as noting that “2% of doctors … take 10% of the $11.6 billion set aside to pay doctors for their services, offices, staff and equipment”.  And what did the Minister propose to do about it? In a classic case of missing the boat, Hoskins wanted to cut fees payable to all doctors. If the Ministry would devote some private-sector-style effort to detecting and deterring fraud, the money that would be saved would not only more than eliminate any need for fee cuts, it would also pay for the fraud detection software, systems, and personnel.

And they can do it.  But they don’t.

Are the Ministries restricted in pursuing fraud by the current legal framework?  That’s covered in part 8 of our series.

There’s Money in Trash. Chinese Companies Are Cashing In

Dynagreen Environment Protection Group, which collects, stores and incinerates garbage, has surged almost 500 percent since its shares began trading in Shanghai on June 11, the best-performance among stocks listed in the city this year. It’s among the waste specialists poised to cash in on China’s carrot-and-stick approach to cope with the world’s biggest trash flow.

The government said this month that households across the nation will, for the first time, have to pay for garbage disposal by 2020 and, separately, that limits on landfills will be tightened. Other recent initiatives include raising recycling quotas in 46 major cities, including Beijing and Shanghai.

Read more at bloomberg.com

PM warns against allowing in global waste

Vietnam must not become a dumping ground for other countries’ scrap, Prime Minister Nguyen Xuan Phuc has warned.

“Authorities need to work in co-ordination to stop scrap from entering Vietnam and affecting the environment and people’s lives,” he said at a meeting of the government’s standing committee on importing scrap Wednesday.

Read more at e.vnexpress.net

10 Shocking Facts About Canada’s Healthcare System – Part 8.

Part 8. Laws And Systems Already In Place To Deal With Fraud

The Criminal Code of Canada is very specific on the subject of fraud:

R.S.C., 1985, c. C-46 says:

Fraud

   380 (1) Every one who, by deceit, falsehood or other fraudulent means, whether or not it is a false pretence within the meaning of this Act, defrauds the public or any person, whether ascertained or not, of any property, money or valuable security or any service,

       (a) is guilty of an indictable offence and liable to a term of imprisonment not exceeding fourteen years, where the subject-matter of the offence is a testamentary instrument or the value of the subject-matter of the offence exceeds five thousand dollars; or

       (b) is guilty

           (i) of an indictable offence and is liable to imprisonment for a term not exceeding two years, or

           (ii) of an offence punishable on summary conviction,

       where the value of the subject matter of the offence does not exceed five thousand dollars.

Minimum punishment

    1. When a person is prosecuted on indictment and convicted of one or more offences referred to in subsection (1), the court that imposes the sentence shall impose a minimum punishment of imprisonment for a term of two years if the total value of the subject-matter of the offences exceeds one million dollars.

Affecting public market

(2) Every one who, by deceit, falsehood or other fraudulent means, whether or not it is a false pretence within the meaning of this Act, with intent to defraud, affects the public market price of stocks, shares, merchandise or anything that is offered for sale to the public is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.

And did you know that there is no statute of limitations for fraud in Canada?   

The Canadian Charter of Rights and Freedoms requires that, once charged, the accused must be tried within a reasonable time. In determining what constitutes a “reasonable time,” the clock starts ticking when the original charge has been laid as opposed to when the crime was actually committed. So for indictable offences, there is no specific time limitation on when an accused must be charged.  Because of this, those who commit serious offences such as rape, murder, and fraud (if over $5,000) cannot avoid facing criminal charges simply because of the passing of time. That loophole does not exist in Canada.

What does this mean?  It means that it’s not too late for the government to backtrack and start hunting down those who have been ripping us off, and hunting them down for real.  There’s no such thing as “it happened too long ago”.

And it is within the power of the courts to hand out meaningful sentences to those convicted of healthcare fraud.  But do they? Read part 9 of our series to find out.

Canada’s Labour Leaders Urge Premiers to Collaborate on a National Universal Pharmacare Plan

During the Council of the Federation meeting in Saint Andrews, N.B., labour leaders from across the country united to deliver a message to Canada’s Premiers – collaboration is critical.

“Canada’s Premiers will soon be asked to support a Pharmacare plan built on a simple principle – equal access. No matter where in Canada you live, you should be able to access the medications you require to live a healthy life,” said Chris Buckley, President of the Ontario Federation of Labour (OFL).

Read more at globenewswire.com

10 Shocking Facts About Canada’s Healthcare System – Part 9.

Part 9. Some Healthcare Fraudsters are Repeat Offenders

 

Some of those accused of perpetrating healthcare fraud seem to make a habit of it.

In 2000 The Globe and Mail reported that 12 doctors were charged with fraud over $5,000 and with conspiracy to commit fraud.  These charges arose from a variety of fraudulent activities including billing for services not rendered and for unnecessary referrals to specialists.  The OPP estimated that the fraud amounted to about $2 million just in the year 1997. The doctors charged all worked at a walk-in clinic owned by one of the doctors charged.  In 2003 this doctor was committed to stand trial on fraud charges but in 2005 The Ontario Superior Court of Justice granted his application to quash his committal.

Fast-forward sixteen years later, the CBC reported that this same doctor  was charged with fraud over $5,000 in a scheme involving unnecessarily referring patients to doctors at a walk-in clinic that he owns (at the same address as the last one, but with a different name).  This clinic’s website promises “rapid access to medical specialists”. I’ll bet. CPSO (the College of Physicians and Surgeons of Ontario) lists this doctor as an active member.

In January of 2017, CPSO found that a psychiatrist was guilty of a number of acts of professional misconduct including what the College is pleased to call “inappropriate billing practices” (the rest of us call it fraud) including:
 

  • billing for missed appointments
  • billing for cancelled appointments (including one the doctor cancelled)
  • billing for telephone calls to patients
  • billing for telephone prescription renewals
  • billing for session lengths some of which were more than double the standard
  • billing ineligible premium codes
  • double billing for the same block of time

The College did not revoke his license for his “inappropriate billing practices” nor for his failure to “maintain the standard of practice of the profession”, and this despite disciplinary action having been taken against him just three years previously for sexual misconduct with patients.   He still maintains his psychiatric practice in Ottawa.

Then there’s the case of the doctor whom CPSO found guilty of various offenses including “inappropriately prescribed high quantities of narcotic medications with too many repeats” as well as not properly monitoring those patients to whom he had prescribed the narcotics.  He failed to provide reasons for ordering tests and changing patients’ medications, and he even prescribed drugs to a patient he hadn’t even seen. The College suspended his license for two months and told him he couldn’t prescribe narcotics any more. After the suspension was up, he continued to practice.  That was December 2010.

In 2016 they hauled him up before the disciplinary committee again, this time for having pled guilty to criminal charges of defrauding OHIP to the tune of $483,916 (and then fibbing about it on a College form).  He resigned his registration with the College. He, at least, is no longer in practice.

But our own personal favourite recidivist fraudster is Dr. Ranjit Kumar Chandra who reputedly fabricated “research” results and then invented another researcher who confirmed Chandra’s results. That’s carrying having imaginary friends a little too far and he was stripped of his Order of Canada appointment  in December of 2015. In August 2016, Chandra was charged with fraud over $5,000 in an alleged scheme to defraud OHIP. I’ll say it was over $5,000! The Toronto Sun puts the number at around $2 million. Police say he paid patients to provide their OHIP numbers (and the OHIP numbers of their relatives and friends) and would then bill OHIP for treatments that he seldom or never provided, and often when he was out of the country.  CPSO got around to suspending his license in February 2017 by which time he’d already beat a hasty retreat, reportedly to India.

But it is a matter of small wonder that there are those in the healthcare field who view committing fraud as a low-risk proposition when you consider that, even when they are caught and convicted, the penalties meted out to the offenders are so light as to be a bad joke in dubious taste.  

Take, for instance, the April 2018 case of two pharmacists in Alberta who pled guilty to taking “secret commissions” of more than $300,000 (and those of us who have no truck with euphemisms call “secret commissions” bribes or kickbacks).  They were ordered to pay some restitution and they each got house arrest for six months followed by a curfew. One of the pharmacists continues to work, and the other returned to a farm in Saskatchewan. No jail time.

Another example is a doctor who defrauded OHIP of $597,760 and WSIB of $2.9 million over a four year period.  This doctor claimed that the “improper billing” was the result of a failure of due diligence. He pled guilty in the Ontario Court of Justice, paid a fine, and made partial restitution prior to his court hearing.  CPSO ordered a three month suspension, a reprimand, an education program, OHIP billing monitoring and costs. No prison time, no revocation of his medical license. He’s currently practicing in Toronto.

Another doctor was found guilty by the Ontario Court of Justice of fraud amounting to $75,000 over a period of four years.  He received a conditional sentence, probation and was ordered to make full restitution by the court. The Discipline Committee ordered a 12­month suspension, with a six month (but with the suspension period to be cut in half if he ponied up $7,500 to the College within six months).  No jail time.

No prison time and no revocation of a criminal doctor’s or pharmacist’s license is not much of a deterrent.

But not all government agencies regard fraud so tolerantly.  A woman in BC was recently sentenced to 4-1/2 years in jail for teaching people how to evade taxes.  Just last year, a Toronto lawyer was sentenced to 3-1/2 years in jail for defrauding condo investors.  A few months ago, a University of Toronto student was sent to jail for 13 months for defrauding CRA. A driver for a vending machine company was convicted of stealing about $20,000 from his employer and was sentenced to four months in jail and was ordered to pay full restitution.

I guess if you want to commit fraud without going to jail, you’d better get some qualifications in the healthcare field.

So what do Canadians think about this situation?  Find out in part 10 of our series.

Waste Is Picking Up! M&A Developments In The Waste Management And Recycling Industry

Read more at mondaq.com