Monitor Telegram

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.

Black-market value of your health information

To adapt to our increasingly just-in-time lives the Canadian health-care system is on an upward trajectory toward digitization. This necessary modernization of health care means better patient outcomes as well as improved insight into future health-care decisions.

Despite the personal and system-wide benefits of a more digital health-care system, what cannot be ignored is that your health information has value to you, but also to people wishing to take advantage or use the information inappropriately.

The fact remains that Canadians may also be unwittingly sharing their health information. Whether it’s apps that are used, mailing lists that are joined, or online surveys, what’s really being tracked is personal health information that tells unscrupulous users information you may not want them to know. If the fine print in the privacy agreement isn’t read and understood, it’s hard to know where your information goes and how it’s used. “Every time you give a little bit away you’re putting yourself at risk.”

Read more at Lethbridge Herald

This is why greedy pharmacists are costing taxpayers millions of dollars

This past week, Global News’ investigative team published an explosive investigation detailing how some pharmacists are making big bucks by scamming the Ontario Drug Benefit Program out of millions of dollars.

The ODB pays for medications for Ontario’s most vulnerable: children, the elderly and those on social assistance. When a qualified patient fills a prescription, they either don’t pay anything or pay a few dollars, and ODB covers the rest.

The program costs the province more than $5.4 billion a year.

Pharmacists bill the province every two weeks for medication dispensed to ODB patients and are paid shortly afterwards.

Dishonest pharmacists over-bill by tacking extra drugs that they never dispensed onto these bills so that they are reimbursed for more drugs than they have sold. Untold millions earmarked for the sick and needy end up in their pockets.

Read the full article at Global News

Pharmacist sentenced for fraudulent PharmaCare claims that benefited low-income patients

Jin Tong (Tom) Li of Richmond receives 12-month conditional sentence after guilty plea

A Richmond pharmacist who submitted thousands of fraudulent claims to B.C.’s PharmaCare system, mainly to save money for his poor and elderly clients, has been sentenced to a year of house arrest.

Jin Tong (Tom) Li, 41, pleaded guilty this week to one charge of obtaining more than $5,000 under a false pretense.

That crime can carry a sentence of up to 10 years in prison, but Provincial Court Judge Georgia Docolas said the 12-month conditional sentence recommended by Crown and defence lawyers was more appropriate.

“This is what I will describe as a low-sophistication crime, committed primarily to benefit his low-income, senior patients,” Docolas said Wednesday.

Nonetheless, she added, Li’s actions have had a serious impact.

“Any time there is a breach of trust involving a public body like PharmaCare … the impact is high because it affects all British Columbians,” the judge said.

Li sold his house to pay back the more than $616,000 he owed the province, the judge said, and he and his wife have had to move in with family. Li is now a stay-at-home dad to their three children while his wife had to go back to school so she could find a job to support the family.

Read the full article at CBC News.

Health minister says ‘action’ is needed but vague on how to stop crooked pharmacists

Ontario Minister of Health and Long-Term Care Christine Elliott said Thursday that she is “aware” of the pharmacy fraud brought to light in a Global News/Toronto Star investigation, adding: “It is something that I take very seriously.”

The investigation exposed pharmacists who are overbilling the Ontario Drug Benefit Program (ODB) and, at times, pocketing hundreds of thousands, — if not millions — of dollars.

“We want to know what’s happening and then what steps need to be taken by the College (of Pharmacists) or by the ministry so it’s probably going to be on both sides that action will need to be taken,” said Elliott.

When asked what steps might be taken, Elliott was vague on details.

The Office of the Auditor General of Ontario has previously called out the ministry on four occasions for having too few inspectors.

“There are 4,200 pharmacies; they only inspect about six per cent a year,” said current auditor general Bonnie Lysyk in an interview. “There’s more money to be recovered.”

“That might be one of the solutions,” said Elliott. “We’re still discussing the situation with the ministry.”

Lysyk said the AG report identified $3.9 million in 2015-16 in inappropriate payments made to pharmacists through the ODB, including $900,000 in billings related to prescriptions being filled for deceased people.

Read the full article at Global News

Pharmacy fraud is costing us millions. Why won’t Ontario take it more seriously?

ANALYSIS: Pharmacists cheat the system to the tune of more than $100 million each year — and the province is doing little to stop them, writes Josh Dehaas

There’s a way to pump millions of dollars into Ontario’s health-care system without raising taxes. All it requires is that the province take the abuse of its public drug plans more seriously.

Karen Voin, who works in fraud prevention for the Canadian Life and Health Insurance Association, says the industry believes that between 2 and 10 per cent of all health-care dollars are lost to fraud. 

Even if you take the conservative estimate — 2 per cent — and apply it to Ontario’s $5.9-billion public drug plan system, it works out to $118 million lost each year. That figure will only rise, given that the province now offers free prescription drugs to people 24 and under.

Yet the Ministry of Health and Long-Term Care is recovering only about $5 million per year from its pharmacy inspections, according to a report released last month by Auditor General Bonnie Lysyk. That includes not only fake billing, but also money paid out by the ministry in error.

Most alarming is that when the province does find potential fraud, it don’t always inform police in a timely fashion — or make sure the money is paid back. And the Ontario College of Pharmacists, the self-regulator, doesn’t always take licences from those who abuse the system.

Put it all together, and it’s clear that not enough is being done to detect and deter fraudsters.

Read the full article at tvo.org

Ontario failing to recover millions in fraudulent OHIP billings by doctors

Ontario’s Ministry of Health is doing little to crack down on doctors who improperly bill OHIP, according to information obtained by CBC/Radio-Canada. 

A freedom of information request shows the province has recovered only $1.1 million in illegitimate billings over the past two years, while the auditor general pointed in her 2016 report to some $6 million in fees improperly paid to doctors. 

“This is a complete waste of taxpayers’ money, taxpayers’ money that was supposed to go to health,” said NDP health critic France Gélinas in an interview with CBC News. 

“It is incomprehensible that when the government sees those kinds of mistakes, that they don’t recoup the money,” Gélinas said.

This suggests little has changed since 2016, when Auditor General Bonnie Lysyk criticized the health ministry for inadequately investigating fraudulent billing and for failing to follow up on physicians with a record of charging  inappropriate fees to OHIP.

“The ministry lacks effective enforcement mechanisms to recover inappropriate payments from physicians,” Lysyk wrote in her 2016 report. “Unless a physician agrees to repay amounts voluntarily, it is very difficult to recover inappropriate payments.”

Read the full article at CBC News

 

Dispensing Harm. How a handful of pharmacists flooded Ontario’s streets with lethal fentanyl amid a national opioid crisis

A burly man wearing a clown mask walks into a pharmacy. Brandishing a large knife, he heads straight for the dispensing counter and hands the pharmacist a note.

The pharmacist, Waseem Shaheen, opens the narcotics safe and fills a white garbage bag with fentanyl patches while the impatient robber waves his knife threateningly.

Shaheen hands over the bag and drops to his knees, hands in the air as the clown robber thrusts the knife through the air a few more times before beating a hasty retreat.

“I got robbed,” Shaheen told a 911 operator minutes later.

“What was taken?” the operator asked.

“Everything.”

Only this was no robbery at all.

It was a charade, concocted by Shaheen to cover up an illicit drug-dealing operation in which he trafficked at least 5,000 fentanyl patches out the back door of his Ottawa pharmacy.

While the provincial government monitors the prescribing and dispensing of opioids in Ontario, no alarms were raised by the conspicuous volumes moving through Shaheen’s pharmacy.

Read more at Global News

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

Part 10. Taxpayers Are Fed Up – And Want Something Done!

We conducted a survey recently to find out just how strongly Canadians feel about the matter of healthcare fraud, and some of the responses might just surprise you. Or not.

90% of those surveyed think that healthcare fraud is a serious concern and needs to be addressed, that fraud of tax money is not a victimless crime.

And they’re right. Losing billions of dollars each year to healthcare fraud is no light matter particularly when, as the Globe and Mail reported in January of this year, “provincial ER waiting times set a record of longest in history” and “even Ottawa’s Children’s Hospital of Eastern Ontario recently warned families about waiting times to treat children in the emergency department”. The article goes on to say that “fully half of our hospitals were operating at or above 100 percent capacity”. Think of how much this dilemma would be eased for us if we were to clamp down on the theft of our healthcare dollars.

73% feel that law enforcement agencies should be responsible for handling cases of suspected healthcare fraud; only 8% would trust this to the Colleges.

And why would anyone think the Colleges are willing to or even capable of appropriately responding to practitioner fraud? The provincial Colleges of Physicians and Surgeons seem dedicated to protecting doctors, not the public. In May of this year, the Toronto Star identified 159 disciplined doctors who held licenses to practice in both Canada and the US and found that fully 90% of these doctors’ public profiles did not report sanctions taken against them for offenses including incompetence, improper prescribing, sexual misconduct and fraud. Furthermore, unlike the U.S., there is no Canadian national database from which you can access licensing and disciplinary action taken on doctors. While the public push for greater transparency of College disciplinary actions has effected some minor reforms in some provinces, some of the provincial colleges remain ultra-secretive about their doings.

An overwhelming 99% think that a doctor or other health practitioner convicted of fraud should go to jail like any other criminal, have their license suspended or revoked, be required to make full restitution, or some combination of the foregoing. Less than one percent thought that just giving back the money and carrying on like nothing had happened is appropriate.

We think that jail time is entirely appropriate for doctors who have committed crimes. Why should they get a pass when others (those not holding medical licenses) have earned themselves prison time for fraud and thefts of lesser amounts?

On the subject of taxpayers funding doctors’ legal defenses, only 12% of survey respondents agree that we should pay their legal bills; 88% feel doctors should pay their own legal bills just like everyone else.

Taxpayers having to fund the protection of doctors accused of wrongdoing – whether medical, civil, or criminal – is outrageous. What other group expects the public to pay their legal bills? Let’s take the hundreds of millions of dollars that we pay to the Canadian Medical Protective Association and put it into hospital facilities instead. And let the doctors buy their own insurance and pay their own legal fees.

When asked about federal involvement in combatting healthcare fraud, the average rating was 7/10 in importance.

One survey respondent sums up the issue nicely:

Healthcare is a Provincial issue. However, justice and criminal code matters are Federal, thus the Federal Government MUST take part.

Also, I do not believe that anything other than the criminal justice system is adequate as professional associations and administrative systems create a two-tier justice system where professionals and ‘white collar’ criminals are treated differently. This allows professionals to operate under a different set of standards and, in my opinion, truly does bring the administration of justice into disrepute.

Finally, as I have actually, personally, investigated instances of institutional health care fraud, as a taxpayer I am disgusted that widespread fraud goes unpunished – even as an administrative or professional association punishment – and simply results in policy changes.

Are there any Ministries out there listening to people’s concerns?

10 Shocking Facts About Canada’s Healthcare System – Part 1

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!  

10 Shocking Facts About Canada’s Healthcare System – Part 2

Part 2. Fraud Costs Canadian Taxpayers $14.5 Billion Annually

If you have not read part one, read it here.

In his book “License To Steal: How Fraud bleeds America’s Health Care System”, Malcolm K. Sparrow, a professor with the Kennedy School of Government at Harvard University says:

“Health care fraud remains uncontrolled, and mostly invisible.  For Americans, this problem represents one of the most massive and persistent fiscal control failures in their history.

“Many who work the system, or feed off it, like it so.

“For those who profit from it, health care fraud is not seen as a problem, but as an enormously lucrative enterprise, worth defending vigorously.”

In the U.S. numerous sources agree that fraud is at least 10% of all health expenditures, and the U.S. is a country that aggressively pursues health criminals to protect taxpayers – we don’t.

That is not to say that healthcare fraud is not an issue in the U.S.  The U.S. National Healthcare Anti-Fraud Association estimates the loss to be in the order of $80 billion each year.   That is a significant amount of money, but it is interesting to note that the U.S. population is almost nine-fold of Canada’s population but their loss to fraud is decidedly not nine times as high as ours.  In Canada the per capita loss from fraud is about 60% higher than that in the U.S based on the U.S. estimates of 10% loss while we conservative Canadians put the average figure at 6%.

How America does it

At least a part of the reason for this discrepancy is that U.S. healthcare insurers, legislators and enforcement agencies take active steps to detect fraud.  And the U.S. does not just pay lip service to the issue of healthcare fraud. When they find it, they go after it with a vengeance, and the perpetrators are very likely to find themselves behind bars!  

  • Just last year, the U.S. Attorney General Jeff Sessions announced that “federal prosecutors have charged more than 400 people in taking part in medical fraud and opioid scam that totaled $1.3 billion in fraudulent billing”.  The 412 people facing criminal charges include doctors, nurses, and pharmacists who, as the Attorney General so correctly noted “have chosen to violate their oaths and put greed ahead of their patients”.
  • In May of this year, a New Orleans physician who had scammed Medicare to the tune of $810,556 was sentenced to prison time followed by a term of home confinement AND had to pay back the $810,556 he’d stolen.  
  • A New Jersey psychiatrist was convicted of fraudulently signing treatment plans with the intention of misleading Medicaid inspectors.  She’s presently contemplating the prospect of five years in prison and a $250,000 fine at her sentencing to be conducted in August of this year.

This is just a small sampling of the vigorous pursuit and prosecution of healthcare fraudsters in the U.S.

Our inactivity

Do the Canadian governments exercise that same diligence in protecting the taxpayers? Emphatically, no, assertions to the contrary from the various Ministries of Health notwithstanding.  

In Canada public healthcare money is issued on demand and without oversight.  And it is this lackadaisical incompetence that has made the Canadian governments’ “efforts” at healthcare fraud control a laughingstock as reflected in Texas attorney James Moriarty’s comment that “OHIP doesn’t have sense to pour piss out of a boot”.

The Canadian Life and Health Insurance Association reported that “All Canadians pay for healthcare fraud. In North America alone, it is estimated that 2 to 10 per cent of all healthcare dollars are lost to fraud [an average of 6 per cent].”  

  • That’s $14.5 billion every 12 months, $39 million a day or $1.6 million per hour.  Every hour, around the clock.   

And do the federal and provincial governments care?  Not on your nelly. They don’t even keep track of the fraud that they do, by some miracle, manage to uncover.  An article in a January 2013 issue of CMAJ (Canadian Medical Association Journal) reveals that there could be “Upwards of $20 billion per year being funneled inappropriately into someone’s pockets.  But a precise breakdown of how much of that is respectively attributable to physicians, or to other health professionals, pharmacies or patients is entirely unknown, as there is no standardized reporting of cases of fraud in Canada or sharing of information between jurisdictions.”

So, what is the government’s documented focus with respect to safeguarding healthcare dollars?  

This is one of a 10-part series.  Stay tuned for Part 3, coming soon!