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.

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?

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.