health care fraud Archives - Monitor Telegram

This is why greedy pharmacists are costing taxpayers millions of dollars

March 11, 2019

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

March 11, 2019

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

March 11, 2019

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?

March 11, 2019

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

Greedy doc loses licence after scamming OHIP for $2M

March 11, 2019

Former Order of Canada recipient Dr. Ranjit Kumar Chandra — who fleeced OHIP for $2 million — has lost his licence to practise in Ontario.

“Dr. Chandra concocted and applied a devious scheme to cheat the Ontario public, at a time when health care funds are stretched,” a College of Physicians and Surgeons of Ontario discipline hearing ruling stated.

“In the circumstances of this case, revocation is the only outcome — there is simply no room in the medical profession for such reprehensible conduct,” stated the decision.

“Dr. Chandra’s conduct directly impacted the public purse and a fine is required for general deterrence,” stated the decision, which also fined him $35,000 — the maximum available — and ordered him to pay the college costs of $16,500.

“When a physician such as Dr. Chandra abuses his power by defrauding the public health care system, he has breached the trust of his patients, his professional colleagues and society at large,” the decision states.

The ruling found Chandra recruited approximately 300 people to his scheme and more than $2 million in OHIP fees were paid to him over a four-year period while he performed little to no medical services.

He billed OHIP almost $200,000 for services while he was in Europe, the Middle East or India, the decision stated.

Read the full article at Toronto Sun

Surrey dentist admits to providing unnecessary treatment, faces fines and six-month ban from practice

March 2, 2018

A dentist with six practices across Vancouver, Surrey and New Westminster has been barred from practicing for six months and must pay a $30,000 fine following his admission of providing substandard treatment.

Dr. Karim Lalani is a general dentist registered with the College of Dental Surgeons of B.C. (CDSBC). His practices include Clayton Heights Family Dental (6758 188 Street), Panorama Family Dental (15240 56 Avenue) and Surrey Family Dental (19188 72 Avenue).

US Law Enforcement Officials Announce Largest Ever Elderly Fraud Case

February 22, 2018

U.S. law enforcement officials on Thursday announced what they labeled as the largest ever fraud enforcement action involving elderly Americans in U.S. history, charging more than 200 people and bringing civil actions against dozens more.

The defendants, many of them foreign nationals living outside the United States, are accused of robbing more than one million elderly Americans of more than $1 billion, the officials said.

New Jersey becomes latest state to sue Purdue Pharma over OxyContin

October 31, 2017

New Jersey filed a lawsuit Tuesday against the company that manufactures OxyContin, claiming a “direct link” between the state’s opioid crisis and the firm’s deceptive marketing practices.

State Attorney General Christopher Porrino says the five-count lawsuit against Connecticut-based Purdue Pharma and two of its entities seeks undisclosed monetary damages for fraud and false claims.

Psychiatrist pleads guilty in fraud case at state psychiatric center

September 20, 2017

TOWN OF MARCY — A psychiatrist at the New York State Psychiatric Center has been fired after law enforcement officials said he lied about treating inmate patients.

While working as a psychiatrist, Morales D. Brown, 59, of Deerfield, lied about evaluating and treating patients and lied on his time and attendance records, according to the state Inspector General’s Office.

Woodstock pharmacist who stole and sold drugs sent to prison for 10 years

September 19, 2017

A former Woodstock pharmacist is facing a decade in federal prison after admitting to stealing and selling drugs and defrauding the Ontario Drug Benefit plan.

Yogesh Patel, 47, stole 3,000 fentanyl and 1,500 hydromorphone patches with a street value of about $1 million between 2013 and 2016 from a Rexall Pharmacy in Woodstock.

Last April, the Kitchener resident admitted to stealing the drugs for the purpose of trafficking and forging documents for about 150 prescriptions.

Patel’s lawyer Jim Dean wasn’t surprised by the lengthy sentence, given all the attention being paid to the nation-wide opioid crisis.