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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.

10 Shocking Facts About Canada’s Healthcare System – Part 3

Part 3. Canada Has No Interest In Fraud, Only In Spending

In the article “What you need to know about the Canada Health Transfer” of December 2016 the Globe and Mail reported “The Canada Health Transfer is the money the federal government sends to the provinces and territories to help pay for health care, which is a provincial responsibility. Ottawa can use the CHT to enforce the Canada Health Act, although, in practice, it rarely does.

The transfer can be clawed back if a province fails to uphold any of the act’s five principles:

  1. universality,
  2. comprehensiveness,
  3. portability,
  4. accessibility and
  5. public administration.

So not only is protecting taxpayers from fraud clearly not one of these five principles, there is no law enforcement unit anywhere in the federal government that exists to deal with it.  Therefore, it is clear that the feds’ health budget is practically free money.

Prime Minister Trudeau’s “health mandate” nowhere even remotely addresses the issue and the Royal Canadian Mounted Police, which is a federal agency that acts as provincial police for numerous provinces, has no health fraud mandate.  Take Saskatchewan as an example, where doctors can use any of 3500 different billings codes and which “to some extent uses the honour system,” to quote a June 2017 article by CBC News.

 

The case of Ontario

The Ontario Ministry of Health and Long-Term Care claims in their website to be “committed to detecting abuse and misuse of the Ontario health care system”.  And who, according to them, is committing the health care fraud? Persons who:

  1. knowingly use a health card that is not theirs
  2. receive OHIP services who are aware that as a non-resident of Ontario they are not eligible
  3. knowingly gives false information to the ministry to become or continue to be an insured person when they are aware that they are not eligible.

The Ministry claims that they investigate “each and every allegation it receives regarding potential health insurance fraud”.  Who do they think they’re kidding? Do they really think that tracking down someone from out of province who is using their cousin Fred’s OHIP card is going to put any kind of dent in the enormous health care fraud bill that taxpayers bear?  The ministry makes NO mention of investigating fraud perpetrated by practitioners. There isn’t even a hint of it.

 

Hindering law enforcement

Ontario, unlike many of the other provinces, at least has established a police unit charged with the detection, investigation and pursuit of health care fraud.  The Anti-Rackets Branch of the OPP (Ontario Provincial Police) has a Health Fraud Investigation Unit, comprised of 19 officers. But as noted in part 2 of our series, the Ministry has been very lax in forwarding suspected fraud cases to the OPP’s Health Fraud Investigation Unit.  

In fact, after waiting in vain for years for the Ministry to send them some cases to investigate, this police unit had to contact the Ministry and ask that they send some.  And what did the Ministry send them? The Unit received 13 cases, eight of which were considered as being too old to investigate. The Ministry stepped up their game in 2016-2017, reporting six cases of possible billing fraud to the OPP, but did not follow up to see whether charges had been laid or the practitioner convicted.  The police, who will vigorously investigate suspected fraud, are being sabotaged by the Ministry.

And even when the officers uncover medical fraud and charge the perpetrators, the sentences are often so light as to be meaningless.

And did you know that pharmacists and doctors convicted of OHIP fraud are very rarely stripped of their licenses to practice by the Colleges that supposedly regulate these professions?  Furthermore, did you know that doctors charged by the police with committing fraud are defended in court by high-priced lawyers that you pay for? Don’t believe it?

This is one of a 10-part series.  Stay tuned for Part 4, coming soon!

10 Shocking Facts About Canada’s Healthcare System – Part 4.

Part 4. When Doctors Are Charged, You Pay Their Legal Bills!

 

When celebrities like OJ Simpson are accused of a crime they are responsible for paying their legal bills.  When mobster Al Capone was arrested in 1931 he had to pay for his legal defense. So did Conrad Black. And Alan Eagleson.  This is the case for everyone. Right?

 

Wrong.  If you are a doctor in Canada you enjoy legal protection of the highest caliber, funded by the taxpayers!

 

In September 2015 the Toronto Star published a scathing indictment of a secretive and largely unknown organization, the Canadian Medical Protective Association (CMPA).  Their article was entitled “Suing a doctor? Your tax dollars will be used against you: Canadian physicians are backed by $3.2-billion war chest indirectly funded in part with public money.”  

 

“Following a medical procedure, you find yourself suffering from a serious, unexpected health issue you believe was caused by negligence.  You decide to sue your doctor for pain, suffering, loss of income and the costs of care. Here’s what you may not know: you won’t just have to pay your own lawyer. Your tax dollars will finance top-flight lawyers to vigorously defend your doctor and challenge your claims.”

 

Yes, readers, that’s right.  The CMPA is a publicly funded defense organization for doctors accused of wrongdoing.  Doctors pay fees to the CMPA and then are reimbursed a hefty percentage from the public coffers, to the tune of hundreds of millions of dollars each and every year.  CMPA financial statements show their membership revenue to be $566.2 million for 2016, and that expenditure has been steadily rising well ahead of the general rate of inflation.  You paid most of that.

 

And just to add insult to injury, the egregious defense campaigns employed by the CMPA hired-gun lawyers financed out of their multi-billion dollar war chest are legendary.  CMPA lawyers are notorious for their “scorched-earth” tactics of:

 

  1. deny the doctor did anything wrong
  2. delay, delay, delay
  3. attack the plaintiff
  4. appeal, appeal, appeal

 

You should also be aware the CMPA does not provide medical malpractice insurance.  The CMPA provides high-priced lawyers to doctors. Very few doctors in Canada have actual liability insurance from bona fide insurance providers (they’d have to pay for that themselves).  Instead, they rely on the publicly funded CMPA to get them out of any scrape they find themselves in.

 

And the CMPA’s financing of a doctor’s defense is not limited to medical malpractice issues; they also fund the defense of a doctor accused of civil or criminal offenses.  Maimed a patient? Operated on the wrong body part? Slandered someone? Sexually assaulted a patient? Got nailed on a DUI? Committed OHIP fraud? Don’t worry – the CMPA lawyers are all over it.  And don’t suppose that the doctor will lose his license to practice if convicted. The Colleges of Physicians and Surgeons, those so-called regulators of MDs and protectors of public safety, are notoriously forgiving of errant, incompetent, and even criminal doctors.  

 

And here’s another disturbing fact: it doesn’t matter how many civil or criminal predicaments a doctor finds himself in – the taxpayer-funded CMPA lawyers will be there for him time after time.

 

Is it possible that you have been an unwitting and involuntary participant in healthcare fraud?  Find out in part 5 of our series…