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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.

Ontario failing to recover millions in fraudulent OHIP billings by doctors

Ontario’s Ministry of Health is doing little to crack down on doctors who improperly bill OHIP, according to information obtained by CBC/Radio-Canada. 

A freedom of information request shows the province has recovered only $1.1 million in illegitimate billings over the past two years, while the auditor general pointed in her 2016 report to some $6 million in fees improperly paid to doctors. 

“This is a complete waste of taxpayers’ money, taxpayers’ money that was supposed to go to health,” said NDP health critic France Gélinas in an interview with CBC News. 

“It is incomprehensible that when the government sees those kinds of mistakes, that they don’t recoup the money,” Gélinas said.

This suggests little has changed since 2016, when Auditor General Bonnie Lysyk criticized the health ministry for inadequately investigating fraudulent billing and for failing to follow up on physicians with a record of charging  inappropriate fees to OHIP.

“The ministry lacks effective enforcement mechanisms to recover inappropriate payments from physicians,” Lysyk wrote in her 2016 report. “Unless a physician agrees to repay amounts voluntarily, it is very difficult to recover inappropriate payments.”

Read the full article at CBC News

 

How Big Pharma deceives you about drug safety

The recent decision of a Saskatchewan judge to reject the proposed settlement between the provinces and Purdue Pharma, the maker of OxyContin, should raise serious questions.

Purdue introduced the prescription drug OxyContin in 1996 and marketed it as safer and less addictive than other opioids. This is now seen by many as the beginning of the opioid crisis in Canada. The settlement in question was meant to compensate patients who were victims of the opioid epidemic and the provinces for some of their additional health-care costs in dealing with the epidemic.

Read more at The Conversation

Former Fraser Health chief Dr. Nigel Murray facing fraud probe in New Zealand over expense claims

Dr. Nigel Murray, the former chief executive officer of Fraser Health who resigned three years ago from his high-paid post in B.C. to take a similar job in New Zealand, has resigned again and remains under a cloud of suspicion there over excessive, unauthorized expense claims.

Murray was the highest paid ($444,000 total compensation) health authority CEO when he worked in B.C. from 2007 to 2014. He then moved back to his native New Zealand but resigned as the chief of the Waikato district board last month after an independent inquiry found numerous potential breaches of his financial obligations.

Read more at Edmonton Journal

Twenty Individuals – Including Four Doctors – Charged with Enterprise Corruption in Massive $146 Million Health Care Fraud

Acting Brooklyn District Attorney Eric Gonzalez, together with United States Health and Human Services Office of the Inspector General New York region Special Agent in Charge Scott J. Lampert, New York City Department of Social Services Commissioner Steven Banks, New York State Medicaid Inspector General Dennis Rosen and New York State Department of Financial Services Superintendent Maria T. Vullo today announced that four doctors are among 34 defendants – 20 individuals and 14 corporations – named in an 878-count indictment that alleges that they participated in a massive scheme to defraud Medicaid, Medicare and other publicly-funded insurance providers of approximately $146 million over three years.

Acting District Attorney Gonzalez said, “These defendants allegedly exploited the poorest among us to divert millions of dollars from publicly-funded insurance programs these same vulnerable people rely on. Some of the defendants then used the stolen funds to maintain a lavish lifestyle consisting of multi-million dollar homes, expensive handbags and luxury travel. This massive scheme, which provided no patient care at all, wasted millions of taxpayer dollars dedicated to Medicaid and Medicare, which serve as a lifeline for so many Americans – our families, our friends, our neighbors. I cannot and will not allow this type of corruption and fraud to take place in Brooklyn and will spend every resource to stop it.”

Read more at The Brooklyn District Attorney’s Office

Former RCMP Officer Comments on Healthcare Fraud

There are a few people in this country concerned about misuse of healthcare funds even though our governments apparently aren’t.

One such individual is a former RCMP officer by the name of John Robert Lyons.  Per his profile on LinkedIn, he was a peace officer with the RCMP for 27 years and prior to his retirement from public service was a fraud risk consultant with the Ontario Ministry of Health and Long-Term Care.

He, with a partner from the United States, now operates The ATRiM Group LLC, a company which provides “services assisting the health care sector deliver counter-fraud training and strategies based in crime prevention science.”

Lyons provided the Monitor Telegram with a copy of a paper he has published on healthcare fraud in Canada.  So we are providing it here for our readers.

[pdf-embedder url=”https://https://monitortelegram.com/wp-content/uploads/2017/08/HCSWhilePaper28final29.pdf” title=”_HCS+While+Paper+final”]

Psych center employee charged with abuse, fraud

MARCY — An employee at the Central New York Psychiatric Center has been charged with defrauding Workers’ Compensation after law enforcement officials said he was caught kayaking on a Caribbean vacation.

Ryan P. Haley, 30, of Rome, unlawfully received more than $2,500 from the state Workers’ Compensation while on pre-planned vacations to Puerto Rico and California, according to the state Inspector General. Haley also physically harassed a Psych Center patient after he returned to work, officials said.

Haley is a security hospital treatment assistant at the Pysch Center, officials said.

Read more at Rome Sentinel

Over 400 charged in health care fraud, opioid scams worth $1.3 billion

WASHINGTON — More than 400 people have been charged with taking part in health care fraud and opioid scams that totalled $1.3 billion in false billing, Attorney General Jeff Sessions announced Thursday.

Sessions called the collective action the “largest health care fraud takedown operation in American history” and said it indicates that some doctors, nurses and pharmacists “have chosen to violate their oaths and put greed ahead of their patients.”

Among those charged are six Michigan doctors accused of a scheme to prescribe unnecessary opioids. A Florida rehab facility is alleged to have recruited addicts with gift cards and visits to strip clubs, leading to $58 million in false treatments and tests.

Read more at thespec.com

 

Health care’s sacred cows targeted

In the 15 months he has been Manitoba’s health minister, Kelvin Goertzen has demonstrated a clear and profound disdain for sacred cows.

The past 90 days alone, Goertzen unveiled plans to close and repurpose three Winnipeg hospital emergency rooms, shutter two dozen rural Emergency Medical Services stations, and cut tens of millions of dollars in operating funds from regional health authorities.

Read more at winnipegfreepress.com

 

3 Whistleblower Suits Net over $60 Million in Medicare Fraud

June 12, 2017 – Whistleblower lawsuits alleging Medicare fraud have been settled against two diagnostic testing companies, and a California doctor who was alleged to have falsely diagnosed cancer as a means to bill Medicare for expensive surgeries.

Medicare fraud remains a prominent issue that has recently garnered renewed calls for increased federal audits and investigation. A key factor for the prosecution of these suits comes from the involvement of whistleblowers, who were central to these three recent settlements.

read more at healthpayerintelligence.com

Whistleblower sues health authority and lawyers, alleging identity revealed

Personal care home employee raised alarm bells in 2011 about financial mismanagement.

A whistleblower who sounded the alarm about financial mismanagement, nepotism and fraud at a West St. Paul personal care home is suing the Winnipeg Regional Health Authority and three lawyers after the person’s identity was allegedly revealed in court documents.

Read more at cbc.ca