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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 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!

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!