With the end of the year in sight, the Better Business Bureau of Vancouver has counted down the top 12 scams of 2007. Many of the usual suspects appeared, including identity theft and internet fraud. However, health care fraud had the dubious honour of taking the number one spot on this year’s list. The Competition Bureau of Canada, noted a startling increase in health care fraud across Canada over the past year, particularly in areas such as miracle drugs, weight-loss claims, counterfeit drugs and fake online pharmacies.

No doubt these types of health fraud represent a serious threat to consumers, the scope of health care fraud goes well beyond this short list. The most common and costly examples of health care fraud include;

1. Bills for services or supplies you, as the patient, did not ask for or receive.

2. When a health care provider performs or prescribes unnecessary procedures or drugs.

3. The use of another persons health card to illegally receive medical treatment.

4. Collection of disability payments when you are not in fact injured.

There are myriad other types of health care fraud, all of which are extremely harmful to us individually and to our health care system as a whole. The best way to protect yourself against any kind of fraud is through education. So in 2008, take the time to develop your awareness of the issues in order to decrease the likelihood that you or someone you care about becomes a victim of health care fraud.

Be part of the solution in 2008!

The Canadian Health Care Anti-fraud Association is pleased to announce the election of Lina Capobianco of Emergis, as its new chair for 2008. The election took place December 14th at the association’s annual general meeting in Toronto.

Ms. Capobianco has worked in both the healthcare and insurance industry for over 20 years. She currently holds the position of Assistant Vice President of Client and Audit Services for Emergis Inc. Her responsibilities at Emergis include leading a team of industry professionals in the detection, education, investigation and prevention of fraud and abuse committed against Insurance Companies and Compensation Boards. In addition, she manages Card Production and Eligibility, Reimbursement, Client Service, Reporting and Projects. Ms. Capobianco also continues to serve on the Board of Directors of the CHCAA.

CONGRATULATIONS LINA !

We would like to thank our outgoing chair, Scott Moore of the Ontario Provincial Police, for all his hard work and leadership in 2007.

THANK YOU SCOTT!

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Report

A couple of weeks ago the CHCAA published a piece about the dangers associated with prescribing drugs that carry a high risk of adverse reaction in seniors (see below Nov 30th). This issue has reappeared recently in the Auditor General of Ontario’s (AG) 2007 Annual Report. While examining the use of prescription drugs at long term care facilities, the AG identified eight drugs that are deemed high risk to seniors. These drugs were being distributed at 30 homes, to about 5700 elderly people across the province. This raises some serious concerns about prescribing practices in Ontario and across Canada.

Comment

While prescribing practices have improved overall in Canada, some disparity still exists on a province to province basis. What this means is that in some jurisdictions there is a greater proportion of these high risk drugs being inappropriately and/or mistakenly prescribed than in others. What’s ultimately needed, is more cooperation between the provinces to improve the standardization of prescribing practices amongst health care professionals.

Regulators and health care providers must also make a concerted effort to ensure that there is sufficient awareness and education about high risk medications amongst all health service providers and patients.