Part 5. You May Have Been Unwittingly Been Involved In A Fraud Scheme
Here’s an all-too-common scenario in Canada, based on one story of an actual patient.
This was a 55-year old man who was experiencing problems with his knee. The family doctor referred him to a specialist in a hospital, but when the patient arrived at the hospital some weeks later he discovered that he was scheduled for a series of tests that had nothing to do with his knee. This included a colonoscopy, among other procedures. Alarmed, he told the doctor’s receptionist that he was surprised that this has happened, as he had been expecting his knee to be looked at, and he refused all the tests. At this point the receptionist started whispering that happened all the time at that facility, and that many administrative staff and nurses were upset about all the unnecessary treatments – especially since it was taxpayers that were billed for it. Billing for unnecessary services is fraud.
Apparently, it’s possible for you to be treated by a doctor who isn’t even in the country. ISB Canada has found cases of physicians billing for services supposedly provided at their local treatment facilities while the doctors were actually overseas!
Have you ever been treated by someone other than a physician such as a nurse or a nurse practitioner? Well, there have been cases where patients were treated by such personnel, yet the treatment was billed as having been performed by a doctor because the rate is higher for doctors. There have even been cases where the treating personnel weren’t even qualified to see patients in any capacity. One psychological care facility hired “therapists” who had had no training in the area, and at least one of these bogus “therapists” was hired because he was a friend of the facility’s owner.
Then there was the case of a psychological facility that had a group of unsupervised patients watching a movie that the facility then billed as “group therapy”.
Believe it or not, you don’t even have to be alive to be unwittingly involved in a fraudulent scheme. TVO reports that the Auditor General’s office found $951,900 had been billed and paid out for prescriptions for people who had already passed away. And that was in one year alone (2015-2016).
You may also have received services that you don’t even know about.
In a recent case in Ontario, a doctor falsely submitted claims for a patient’s non-existent conditions. As a result of these imaginary conditions being entered into her medical records, she was unable to get private travel insurance. When she discovered the falsification and asked OHIP to remove the false information from her file, they wouldn’t do it because payments for the procedures had already been made. The patient sued the doctor and one of the doctor’s former employees for fraud.
In one Ontario case, a doctor had labeled many of his patients as having a mental problem and billed the Ontario Health Insurance Plan (OHIP) for these supposed illnesses. The patients knew nothing of this.
Can you imagine going in for a foot problem and getting labeled schizophrenic? Your future is altered and not for the good, and the doctor gets paid by OHIP for it – even though it’s false. Worse still, OHIP might not correct your records!
There are many, many other scenarios you can watch out for. One common example is “unbundling.” In this scheme, a practitioner or a facility takes a bundle of services that are commonly delivered together, and are bundled by the insurance provider at a discounted rate, and bill for the services separately for a higher total rate.
So, just how many ways are there that dishonest practitioners can use to steal money from us? Find out in part 6 of our 10-part series.