Our CHF blog will enable the Canadian public about serious issues of health fraud. In particular, we will address insurance fraud against our Provincial health insurance providers.
In an age where every Canadian is guaranteed health care funded by the public purse, no matter what their station in life, there are still physicians who put their pockets and bank accounts ahead of providing services to their patients.
In particular, we will look at the apparent failure of fiscal oversight that our Provincial watchdogs have demonstrated over the last decade or so. The Ministry fails to provide Access of Information requests to the public in regards to physicians' income, group budgets, and actions taken against any medical group or single physician who has questionable billings.
In fact, as far as I know, there is NO ceiling on physician incomes whether they are in a group or practicing in a solo practice in Ontario. How was this allowed to happen?
Recently the issue of funding FHOs (Family Health Organizations) has surfaced here in Ontario. What was originally set up by the MOHLTC (Ministry of Health and Long Term Care) to provide continuous and guaranteed coverage for patients has instead allowed some of these physicians to walk away with the "bank".
There have been allegations that the alleged fraud by Medical doctors has been made possible because of sloppy and careless MOHLTC departments that allowed these group practices to grow without control.
The Ontario government, having their purses shrink drastically over the last few years had to do something about this ripoff. In March 2014, the government basically said NO to new FHOs and other group practice structures. That meant that doctors new to Ontario could no longer join these groups. Instead of starting off with a huge guaranteed salary with these groups, new doctors would have to settle for a fee-for-service structure.
The OMA (Ontario Medical Association) has been facing claw-backs of their members' fee structure, and have been unable to help. What the OMA has failed to mention is the fact that the group practice framework in this Province has for the most part failed to provide the 24/7 coverage for the patients.
The opinion of some doctors over the years has been that the groups have been paid way more than they are worth.
When some doctors formed groups, instead of providing full coverage, some doctors basically took a bloody holiday from practice, cut back their working hours, and relied on the Ontario TeleHealth 1-800 call-up service that basically told the callers to go to the local walk-in clinic or ER when there was nobody that was supposed to be on-call for their group. It has been a real mess, and it's just getting worse.
One particular organization basically told the government that they would expand their services by taking over the practices of retiring doctors and agreed to sign their patients up to physicians who they have contracted with to join their FHO. In return, these entrepreneurs were entitled to receive funding up front for these former physicians, whether they were in the office to service the patients or not.
Physicians were given 2,000 or more "rostered" patients to look after. But, in reality they were allowed to filter out those who were perhaps too complex to look after. Did the government know that this would happen? I don't think that they did, nor do I think that they cared.
We will focus on the situation here in Ontario for the most part. But, it is clearly not just here in Ontario. Regulatory Colleges across Canada are also partially responsible for ignoring the issues of health fraud. This brings to mind the awful history of cross-Canada doctor fraud.
A physician who commits health fraud in one Province, seems to be able to just jump from one to another without any College caring a bit.
In a recent Ontario case, a physician was basically forced out of the Province and went to his home across the country. The charges against them were never made public. Why even the database of the CPSO (College of Physicians and Surgeons of Ontario) still has him listed as being active, even though he left the Province many months ago. There is no link to disciplinary actions pending against them here. There is no transparency here.
But, the RateMDs.com web site has registered many complaints against them. Unfortunately, these complaints are anonymous. When asked by members of the public why the CPSO does not have information about why this MD is no longer in the Province, they conveniently duck the issue.
When reliable information about a police investigation into alleged massive health fraud at the offices of an Ontario FHO surfaced a few months ago it really got down and dirty. Allegations of padding the bills, providing services that were never done by MDs, and much more were made by members of the public when they called the Ontario Provincial Police's Fraud Line.
I can't say how many complaints have been made over the years by patients of these physicians to the CPSO. None of these complaints will ever be made public, until these doctors are brought before a disciplinary committee. I also don't know if there have been any lawsuits against any of the physicians.
Suffice it to say, that if just a fraction of the allegations that have been made were even partially true, the physicians involved have a long way to go to try to clear their name.
Then there is the matter of other allegations that are presently being investigated by the police in two Provinces. Because of possible legal action we are unable to discuss this here.
We of course, will try to keep you posted as things develop.
My suggestions to anyone who feels that they may have been involved in any health fraud that involves medical doctors is basically to call their Provincial Fraud Line AND file a complaint with their College of Physicians and Surgeons.
The Canadian Anti-Fraud Centre can be reached on their web site to start the ball rolling if you really suspect health fraud. Your Provincial College of Physicians Surgeons and the respective Colleges of Nurses have limited resources and often rely on this agency to do their investigations.
http://www.antifraudcentre-centreantifraude.ca/english/index.html
The Canadian Anti-Fraud Centre can be reached by phone by calling
1-888-495-8501
But, in my opinion, their web site is really easy to negotiate and you can get your complaint registered anytime. So, go to their web site and let them know you are concerned.
Thursday, May 7, 2015
Wednesday, May 6, 2015
List of Canadian Colleges of Physicians and Surgeons
Click on the links below and then look for "File a Complaint" to enter the details if you think that your RN has been treating you for things like Botox or Restylane or other injectable without an MD in the office. The name of the MD needs to be posted in the spa, and if they don't tell you who it is, run fast to the exit. But, finish reading this blog to take action.
A cosmetic clinic or spa can obtain the prescription injectables by hiring a MD who basically acts as a go-between the distributor and the patient. The MD, for instance, can give a public injection at a woman's health fair in front of hundreds of people in the audience and say something like this:
"We can bill the Province for a procedure that may not be covered, like Botox. So just come into the office and we can tell the Province that the Botox was for your migraines", not your wrinkles or frown lines" .
If the RN in question sees you without a MD in the office, they an get in trouble with their regulatory bodies or Colleges. Some Canadian MDs have been known to "service" up to a dozen or more spas or clinics without ever setting foot inside their locations. It's called "Botox-by-Proxy".
As a consumer, paying for cosmetic treatments, consider that it could cost you more than money. If the owner/operator of the local spa seems to be doing things above and beyond you would expect, then ask questions:
1. Who is the doctor in charge?2. Where are they now?
3. Who owns the spa?
4. Do they have malpractice insurance?
5. How does the Botox get to the spa?
6. Where are the RNs trained who work there?
7. How long have they been doing this, and have they had any complications?
Here are the links to the Colleges of Physicians across Canada
College of Physicians and Surgeons of British Columbia
College of Physicians and Surgeons of Alberta
College of Physicians and Surgeons of Saskatchewan
College of Physicians and Surgeons of Manitoba
College of Physicians and Surgeons of Ontario
Collège des médecins du Québec
College of Physicians and Surgeons of New Brunswick
College of Physicians and Surgeons of Nova Scotia
College of Physicians and Surgeons of Prince Edward Island
College of Physicians and Surgeons of Newfoundland and Labrador
Health and Social Services - Government of the Northwest
Territories
Department of Health and Social Services - Government of
Tuesday, May 5, 2015
List of Canadian Colleges of Nurses Regulators
Click on the links below and then look for "File a Complaint" to enter the details if you think that your RN has been treating you for things like Botox or Restylane or other injectable without a MD in the office.
"We can bill the Province for a procedure that may not be covered, like Botox. So just come into the office and we can tell the Province that the Botox was for your migraines", not your wrinkles or frown lines" .
Here are the lists for the Colleges of Nurses across Canada
BRITISH COLUMBIA
College of Registered Nurses of British Columbia
2855 Arbutus Street Vancouver BC V6J 3Y8
Tel: (604) 736-7331 Fax: (604) 738-2272
E-mail: info@crnbc.ca
ALBERTA
College and Association of Registered Nurses of Alberta
11620 - 168 Street Edmonton AB T5M 4A6
Tel: (780) 451-0043 Fax: (780) 452-3276
E-mail: carna@nurses.ab.ca
SASKATCHEWAN
Saskatchewan Registered Nurses' Association
2066 Retallack Street Regina SK S4T 7X5
Tel: 1-800-667-9945 / (306) 359-4200 Fax: (306) 525-0849
E-mail: info@srna.org
MANITOBA
College of Registered Nurses of Manitoba
890 Pembina Hwy Winnipeg MB R3M 2M8
Tel: (204) 774-3477 Fax: (204) 775-6052 E-mail: info@crnm.mb.ca
ONTARIO
College of Nurses of Ontario
101 Davenport Road Toronto ON M5R 3P1
Tel/Tél. : 1-800-387-5526 / (416) 928-0900 Fax/Télécopieur : (416) 928-6507
E-mail/Courriel : cno@cnomail.org
QUÉBEC
Ordre des infirmières et infirmiers du Québec
4200, boul. Dorchester Ouest Montréal QC H3Z 1V4
Tel/Tél. : (514) 935-2501 / 1-800-363-6048 Fax/Télécopieur : (514) 935-1799
E-mail/Courriel : inf@oiiq.org
NEW BRUNSWICK
Nurses Association of New Brunswick
165 Regent Street Fredericton NB E3B 7B4
Tel/Tél. : (506) 458-8731 Fax/Télécopieur : (506) 459-2838
E-mail/Courriel : nanb@nanb.nb.ca
NOVA SCOTIA
College of Registered Nurses of Nova Scotia
Suite 4005 7071 Bayers Road Halifax NS B3J 2A8
Tel: (902) 491-9744 Fax: (902) 491-9510
E-mail: info@crnns.ca
PRINCE EDWARD ISLAND
Association of Registered Nurses of Prince Edward Island
53 Grafton Street Charlottetown PE C1A 1K8
Tel: (902) 368-3764 Fax: (902) 628-1430
E-mail: arnpei@pei.aibn.com
NEWFOUNDLAND AND LABRADOR
Association Of Registered Nurses Of Newfoundland And Labrador
55 Military Rd St. John’s NL A1C 2C5
Tel: (709) 753-6040 Fax: (709) 753-4940
E-mail: info@arnnl.nf.ca
NORTHWEST TERRITORIES
Registered Nurses Association of the Northwest Territories and Nunavut
Box 2757 Yellowknife NT X1A 2R1
Tel: (867) 873-2745 Fax: (867) 873-2336
E-mail: nwtrna@theedge.ca
YUKON Yukon Registered Nurses Association
204 - 4133 - 4th Avenue Whitehorse YT Y1A 1H8
Tel: (867) 667-4062 Fax: (867) 668-5123 E-mail: yrna@yknet.ca
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