The Renaissance Hotel in Toronto was the site for the most recent event in the CHCAA’s Health Care Fraud Educational Series 2008. Last Thursday evening, the Auditor General of Ontario, Mr. Jim McCarter, sounded out a strong message about the need to ramp up resources in the public sector in order to combat the threat of health care fraud. He identified OHIP and the Drug Benefits Program as the highest risk areas for fraud. He pointed to the continued wide spread use of the old red and white health card as a major area of concern for OHIP. While an inadequate system of checks and balances allowed drug benefits fraud to go undetected in a number of instances.

Mr. McCarter spent most of his time focusing on the many solutions that may help to prevent and detect fraud in the public system. He identified technology solutions like data mining as the most important tool in fraud containment because it helps regulators to pinpoint the most common areas of fraud and abuse, allowing them to more effectively direct their efforts and resources. He also cited the need for stiffer fines and penalties for health care fraud. Compared to both the UK and US, Canada metes out some of the most benign sanctions for health fraud.

Underlying any effective solution to this problem is the prioritization of health care fraud by government. As health care spending continues to climb, the total amount of money lost to fraud will follow a similar trajectory. Protecting the integrity of the health care system should be atop any provincial or federal governments to do list. Policy makers need to respond to this issue by channelling more funding and resources to government bodies charged with the protection and risk management of the health care system. Most importantly they must invest more in educating the public about the risks of health care fraud and how they can help to prevent it.

Your medical records contain some of your most intimate personal details. Therefore, an implicit understanding exists that these records will be treated with the utmost care and security by their custodians including doctors.

However, the Hamilton Spectator recently reported that patient records were found scattered around a dumpster behind a Etobicoke coffee shop. The records were identified as belonging to seven children from St. Joseph’s Hospital located in west end Toronto. The hospital has retrieved the records and issued a formal apology to the families of the children. The doctor may face potential disciplinary action from the College of Physicians and Surgeons of Ontario for a breach of patient confidentiality as guaranteed under law.

Organized crime is modernizing, and has evolved beyond it’s traditional bread and butter criminal activities. According to recent reports, the Mafia has broken into the information trade in a big way. They are said to be stealing thousands of identities not only for cash and credit cards but for health insurance information. Once stolen, this information is used by dummy corporations to bill insurance companies for high value health products like wheel chairs, which also have a quick turnaround time on payment. The criminals acquire the patient information by planting an individual in employment positions where they will have access to patient records. The information is then siphoned off and used to produce false claims.

This has a whole host of significant implications for consumers who’s physical and financial health can be placed in grave danger by medical identity theft. According to a 2006 report published by the World Privacy Forum, “fraudsters who use your identity for medical care or services can introduce changes to your medical record that can be nearly impossible to undo.” That means that false health/personal information may be entered into your record and remain there permanently. This can drastically impact your credit rating and your insurability. More alarmingly is the prospect that a “doctored” health record can even lead to physical injury or death. You may be treated with the wrong medication or misdiagnosed as a result of inaccurate information in your medical file.

Click here for tips on what to do if your medical identity is compromised.

Protect yourself and your health. Be an informed consumer.