Presentations - Abstracts

Program Registration Presentations Sponsorship Hotel


Day 1:

Master of Ceremonies:
Eric Girard, Sun Life

Day 2:

Master of Ceremonies:
Dan Berty, Sun Life

  • Welcoming Remarks:
    Sue Henry, WSIB

  • Keynote Address:
    Dr. Michael Rachlis , Private Consultant

  • Closing Remarks:
    Joel Alleyne
    , Executive Director, CHCAA




The ABC's of Dental Consulting
Dr. George Glasser, University of Western Ontario.

Over the past thirty years, there has been a substantial increase in patient accessibility to dental insurance. In the ensuing period, the role of the dental consultant has changed and evolved into one of assessment and determination of billing abuse and fraud. Dr. Glasser will review various cases that have resulted in restitution of monies to the carrier and/ or precipitated an investigation by the provincial regulatory body.

Dr. Glasser will also present examples of unusual treatment submissions, which includes restorative and prosthetic; periodontal therapy (including soft tissue management) and those submissions that may have been deemed to have a poor prognosis.

Dr. George Glasser

Dr.Glasser received his DDS in 1972 from the University of Toronto and his Certificate of Periodontics from Dalhousie in Halifax in 1987. He has held positions as Clinical Instructor in the Department of Fixed Prosthodontics, Associate Professor of Periodontics and is presently Clinical Associate Professor of Periodontics at the University of Western Ontario

Dr Glasser has maintained a private practice limited to periodontics and implants and currently is a consultant in the Investigative Services Department at Sun Life Financial/Clarica.

Dr Glasser has presented numerous seminars and lectures not only in his specialty but as well on the topic of dental insurance.

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Auditing of Provider Contracts-Risk Management
Ira Goldman, Worker's Compensation Board, Alberta.

Mr. Goldman's presentation will be on auditing health care provider contracts with a focus on how companies can use audit as a tool to monitor performance and ensure they receive services billed. The presentation will include audit considerations for risk management, audit methodologies, data mining, and internal versus external recommendations.

Ira Goldman

After graduating from Law School in 1986, Ira Goldman practiced Law with an emphasis on Insurance and Workers Compensation. He joined the Worker's Compensation Board of Alberta in 1988 and, since that time, has gained diverse experience and helped to contribute to the success of the corporation. Most notably, he has extensive experience in the development and building of quality assurance models and processes with an emphasis on efficiency, quality and accountability. In 1996, as Supervisor of Premium Audit, he was responsible for reporting on the appropriateness of over $700 million in insurable earnings paid by employers to the WCB. In 2000, he headed the creation and development of the Health Care Audit unit where he continues to assist the corporation in managing it's investment of over $150 million in health care expenditures annually by using best in class techniques and novel approaches. This year, Mr. Goldman was appointed by Gary Mar, Minister of Alberta Health and Wellness, as a committee member to administer provisions under the Health Professions Act.

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Taking the Profit Out of Crime
Pat Rakus, Canada Customs and Revenue Agency.

Mr. Rakus' presentation will focus on the Special Enforcement Program, which is carried out by the Investigations division of the Canada Customs and Revenue Agency. His presentation will provide details on how the Agency collects information and uses its regulatory powers to assess individuals involved in criminal activity.

Pat Rakus

Pat Rakus joined the Canada Customs and Revenue Agency in 1975. He has worked out of the Toronto Tax Services office throughout his career. Mr. Rakus began as a payroll auditor and moved on to other areas such as office audit, assessing, client services and electronic filing. Currently he is in the Investigations division of the Canada Customs and Revenue Agency assigned to criminal intelligence and police liaison.

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Dental Investigations - Sharing Perspectives
James G. Cameron, Cameron & Ballantyne, and
David Bisch, Manager, Investigation Services, Manulife Financial.

James G. Cameron

James Cameron was called to the Quebec Bar in 1986 and to the Ontario Bar in 1991. He holds a BA from Queen's University, an LLB & BCL from McGill University (Civil & Common Law) and a D.E.S.U from Universite d'Aix-Marseille. He is a member of the Canadian Association of Labour Lawyers, the County of Carleton Law Association., the Advocates Society, and the Association des Juristes d'expression francaise de l'Ontario.

James provides legal services in both official languages and is licensed to practice in both Ontario and Quebec. In addition to his labour and employment practice, James also practices general civil litigation and has acted as counsel to arbitrators and chairs of major inquiries and arbitrations. He appears frequently before the federal court, courts of Ontario and Quebec, Human Rights Tribunals, Labour Boards and arbitrations.

David Bisch

David Bisch, Manager, Investigation Services, has been employed with Manulife Financial since 1994 in a variety of roles within Group Benefits ranging from claims payment to systems and business analysis. David currently manages eight staff committed to health care fraud and claims abuse management. David holds a Bachelor of Arts in Economics from the University of Waterloo and is a member of the Association of Certified Fraud Examiners, the Canadian Association of Special Investigation Units, the National Health Care Anti-Fraud Association, and the Canadian Health Care Anti-Fraud Association.

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The power of partnerships in tackling health care fraud
Chief Jack Ewatski, Winnipeg Police

Keeping crime rates and insurance rates in check is no small feat - especially in this cost-conscious age of limited resources. Law enforcement agencies and insurance industry stakeholders are making serious inroads in the matter by working co-operatively to combat issues like healthcare insurance fraud.

Chief Ewatski discusses some of the successful partnerships the Winnipeg Police Service has fostered with local insurers in the never-ending battle against fraudulent insurance activities.

Chief Jack Ewatski

Chief Ewatski began his policing career with the City of Winnipeg in 1973. He has worked in all branches of the Service, spending the majority of his career working in the area of criminal investigation. He was appointed Chief of the Winnipeg Police Department in November 1998. He is a graduate of several courses at the Canadian Police College, the Federal Bureau of Investigation's National Academy and National Executive Institute. He holds certificates from the University of Virginia as well as Harvard University. He is a Vice President of the Canadian Association of Chiefs of Police, a member of the International Association of Chiefs of Police and the Major Cities Chiefs Organization.

Chief Ewatski sits on many boards and committees including the Canadian Police College's Advisory Board and the Canadian Association of Chiefs of Police Organized Crime Committee. He has developed expertise in the area of emergency response and management and has lectured extensively in Canada and Europe on this subject. Chief Ewatski is leading the 1500 members of the Winnipeg Police Service with a community policing philosophy and a commitment to excellence in service delivery.

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Mary Lou Oakes

Mary Lou Oakes is Director of Investigative Services at Sun Life Financial. Employed by Sun Life Financial (formerly Clarica/Mutual Life of Canada) for 32 years, she was previously Director of Pensions and Director of Claims/Infocentre. Mary Lou is passionately committed to preventing and detecting fraud. She founded the Investigative Services department at Clarica seven years ago, emulating the property and casualty industry since few Canadian models were available in the health care sector. Under her direction, Clarica became the first Canadian member of the National Health Care Anti-Fraud Association and a founding member of the Canadian Health Care Anti-Fraud Association.

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Greta Cusworth

Greta is Vice President, Group Benefits for Sun Life Financial. She is responsible for all of the Group Benefits operations. Prior to joining Sun Life Financial, Greta had an extensive career in the group benefits business with Confederation Life and Manulife Financial in the areas of underwriting, sales, marketing and quality service.

Greta graduated from Queen's University with a degree in Mathematics. She has earned both the FLMI and HIAA designations.

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Eric Girard

Eric Girard is Vice-President, Group Claims, at Sun Life Financial. He is responsible for the overall management of Group Life, Disability, Health and Dental Claims and the Call Centre functions. Prior to undertaking this role Eric was in charge of the Group Underwriting Department. Eric also has extensive experience with other insurance companies, mainly in the areas of Underwriting and Client Services.

Eric holds a Bachelor of Science degree from Queen's University, a Bachelor of Education degree from the University of Toronto and is a Fellow of the Life Management Institute (FLMI).

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Sue Henry

Sue Henry is the Manager, Health Care Fraud Control, Strategic Compliance Branch, Workplace Safety and Insurance Board (WSIB). She is currently developing a strategic health care fraud control program that will provide the WSIB a balance between fraud prevention, early detection, and appropriate responses including investigation and prosecution. She is formerly an Investigative Manager, and Senior Investigator who specialized in the investigation of health care provider fraud.

As Chair of the Canadian Health Care Anti-Fraud Association (CHCAA) Sue is committed to raising the level of national awareness to the problem of health care fraud. She actively participates on the CHCAA Conference Planning and Marketing Committees, practitioner sub-committees, and facilitated the creation of the Dr. Mazak Award for excellence in health care fraud journalism.

Sue is a former microbiologist, public health inspector, and Ministry of the Environment investigator. This background led to an investigator position with the original civilian Ministry of Health, Health Investigations team in 1994, and started her career in the health care fraud field.

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Value of Independent Medical Exam (IME) / Functional Medicine Evaluation in Dispute Resolution
Dr. Jack Richman, Medical Director, AssessMed
 
The IME must be an evidence-based objective and impartial medical evaluation. To be of value, there must be a process that can actually determine the presence or absence of medical impairments. If there are impairments, the process must then be able to determine the impact of these conditions, if any, on functional abilities. Then the process must be able to determine the validity of such data through effort testing. Finally, the results of this IME process must be reported in such a way as to assist the referring source in managing the claim.    

Dr. Jack Richman

Dr. Jack Richman is the Executive Vice-President and Medical Director of ASSESSMED. Dr. Richman, after being in Family Practice from 1968 to 1977, specialized in Occupational Medicine, Pain Management and Disability Evaluation.

Dr. Richman is a Founder and first President of the Canadian Society of Medical Evaluators and past Chair of the Standards Committee. He is a Diplomat of the American Academy of Pain Management and a founding Member of the Canadian Pain Society and the International Association for the Study of Pain. He is founder and first President of The Ontario Society of Occupational and Environmental Medicine, a Diplomat of the American Board of Forensic Medicine, a fellow of The American College of Occupational and Environmental Medicine, a Diplomat of Occupational Health and Safety at McMaster University, a Certificant of the American Board of Independent Medical Evaluators (CIME), a Certificant of the Canadian Board of Occupational Medicine, a Certificant of the College of Family Physicians of Canada, and a Fellow of the American Academy of Disability Evaluating Physicians.

He is past Chairman of the Work Fitness / Disability Evaluation Section developing standards for disability evaluations. He is past Chair of the Committee for Accreditation in Occupation and Environmental Medicine Quality Assurance of the American College of Occupational and Environmental Medicine. Dr. Richman has served as an expert witness in arbitration, court, and WCAT (Workers' Compensation Appeals Tribunal) hearings in Occupational Medicine. He is a roster physician for the Workplace Safety and Insurance Board (WSIB) and is an examiner for the Coast Guard. He was Supervisor to the Elective on Acupuncture and Alternative Therapies at The University of Toronto Faculty of Medicine for 19 years.

Dr. Richman graduated from the University of Toronto in 1967. He has practiced Occupational Medicine part time since 1968, and full time since 1977. He is Corporate Medical Consultant for Woodbridge Foam Inc., and Hatch. He served on the Board of Directors of the Accreditation Association for Ambulatory Health Care and on the Accreditation, Standards and Surveyor Education and Training Committees and he is an active surveyor. He has served as Medical Director for Atomic Energy of Canada, Goodyear Canada, Canadian General Electric Lighting Products, St. Lawrence Cement Co., the Town of Oakville, Molson Breweries Ltd., as well as other major corporations.

Dr. Richman is a consultant to the AMA Guides to the Evaluation of Permanent Impairment Newsletter. He is on the Medical Advisory Board to the publication "The Medical Disability Advisor". His practice for the last 27 years includes the evaluation and treatment of pain.

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Dan Berty

Dan has been with Sun Life Financial for 20 years. Prior to joining Group Benefits in 1996, Dan held various Information Technology roles including systems developments, network management and network architecture. Since then, he's had a number of Group Claims operation leadership positions in Edmonton and Ottawa. As Health and Dental AVP, Dan is presently accountable for Sun Life Financial's Health and Dental Claims operations nationally.

Dan graduated in 1982 from the Data Processing Program at Dawson College in Montreal.

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OxyContin - Abuse / Diversion Scams
Detective Constable Mark Gauthier - Ontario Provincial Police, Drug Enforcement Section

Prescription drug abuse is the intentional misuse of medicine outside the normally accepted standards for its use. It is the use of a legal drug in a manner inconsistent with its original purpose. Drug diversion is the channeling of legally manufactured and distributed pharmaceutical drugs to individuals who have no right to possess them.

Detective Constable Gauthier's presentation will focus on the highly publicized narcotic OxyContin and how it is being abused and diverted in Canada and the United States.

Detective Constable Mark Gauthier

Mark began his policing career with the Ontario Provincial Police in 1996. He served at Cumberland, Ottawa and Aurora Detachments conducting uniform duties before joining the Drug Enforcement Section - Toronto Unit in 2001. In 2002, Mark was assigned as the Toronto Unit's Double Doctoring Investigator working with the OPP's Health Fraud Investigation Team.

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Using Negotiation and Alternate Dispute Resolution Techniques in Health Care Fraud Cases
Thomas J. Lockwood, Q.C., Lockwood and Associates

Mr. Lockwood's presentation will explore how various Alternative Dispute Resolution Techniques can be employed in conjunction with or as a replacement for the standard criminal charge route in Health Care Fraud cases. Reference will be made to the recent positive experience of the Ontario Workplace Safety and Insurance Board in this area. The presentation will concentrate on the identification and achievement of cost beneficial results for the health care fraud victim.

Thomas J. Lockwood, Q.C

After graduating from Osgoode Hall Law School in 1967, Thomas Lockwood specialized in litigation and administrative law. In 1973, he became a partner in the firm of Lockwood, Bellmore & Strachan and in 1990 Mr. Lockwood became the sole proprietor of Lockwood & Associates. He was appointed Queen's Counsel in 1982. Mr. Lockwood's career includes counsel work before the Superior Court of Justice, the Ontario Court of Appeal, the Supreme Court of Canada, the Ontario Municipal Board, the Ontario Securities Commission, the Workplace Safety and Insurance Board and various other disciplinary bodies of the Law Society of Upper Canada.

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New IBC Initiatives to Fight Organized Injury Fraud
Robert Whitman, Director, Ring Investigations, Insurance Bureau of Canada
Richard Dubin, Vice-President, Insurance Bureau of Canada's Investigative Service

This session will deal with the new initiatives implemented by IBC in their committed fight against Insurance Fraud related to staged motor vehicle accidents and health issues. Richard and Bob will talk about fraud detection software, VisiCAIS , criminal analysis to detect organized insurance fraud, the new 'Web Claims Submissions, ACE submission and value of quality data, expansion of the Rings Investigative Unit, , new initiatives with the Attorney Generals Office and fraudulent trends in the industry.

Robert Whitman

Robert Whitman is National Director of Ring Investigations for the Insurance Bureau of Canada (IBC). He has extensive experience as a senior fraud investigator in the insurance industry and now uses his expertise at IBC to fight organized insurance fraud.

Bob worked for the Metro Toronto Police Force achieving the rank of Detective Sergeant with the York Regional Police Force for a total of 35 years in policing. He has an Honours diploma in Law Enforcement from Seneca College and is a Certified Fire Investigator.

Bob is currently a member of several SIU organizations. In recent years, he was a Director of the Canadian Association of Special Investigation Units and Regional Director of the International Association of Auto Theft Investigators. Through these experiences, he understands the frustration and challenges met by the insurance industry in the fight against fraud. He is committed to raising national awareness about organized crime and staged accident fraud, and their effect on health and insurance providers.

Richard Dubin

Richard Dubin is Vice-President of the Insurance Bureau of Canada's Investigative Services. Mr. Dubin leads over 60 investigators including team leaders who, together, serve about 90% of the property and casualty insurance sold in Canada.

Mr. Dubin has extensive experience in the Property and Casualty insurance industry. He has held the positions of Ontario Claims Manager, Manager of Special Investigations Unit, National Manager of Property Claims and Director of Corporate Office Claims Services.

At IBC, Mr. Dubin has developed new customer service standards to ensure client satisfaction, increased the volume of investigations and developed the first rings investigative unit to address organized insurance fraud. He is a member of both the Canadian Insurance Claims Managers Association and the Board of Directors for the Canadian Association of Special Investigation Units. Mr. Dubin has a law degree from the University of Ottawa.

 

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Privacy and Consent Issues
Michal Fairburn, Ministry of the Attorney General, Crown Law office, Criminal

Michal Fairburn's presentation will focus on privacy issues at the investigative stage. In particular, she will discuss the relevant privacy interests engaged; when section 8 of the Charter and the right to be secure from unreasonable search and seizure governs; the intersection between state and non-state actors; and how to obtain a constitutionally valid consent.

Michal Fairburn

Ms. Fairburn obtained a B.A. in 1987 and an LL.B in 1990 from the University of Toronto. She articled at the Crown Law Office - Criminal. She was called to the Bar in 1992.

Ms. Fairburn appears in all levels of Court, but most often in the Court of Appeal for Ontario in criminal related matters. Ms. Fairburn has significant experience in all areas of the criminal law, including search and seizure, wiretap, and media related issues. She is an active participant in all areas of ongoing education to police officers, lawyers and Justices.

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Interviewing Techniques
Detective Staff Sergeant Pat Finnegan, Ontario Provincial Police

Detective Staff Sgt. Finnegan's presentation will highlight practical interviewing techniques which will assist the criminal or regulatory investigator in becoming a more effective interviewer.

Detective Staff Sergeant Pat Finnegan

Detective Staff Sergeant Pat Finnegan has been with the Ontario Provincial Police for 15 years with the last 9 years in criminal investigations. He is currently the acting team leader of Eastern Ontario Economic Crime Team, specializing in Health Fraud Investigations - Anti-Rackets.

Pat is a member of the Major Case Management Training Sub-committee and lead trainer of the Ontario Major Case Management Course. He lectured on Major Case Management and Search & Seizure across Ontario for the past four years (recently lectured in Turkey and Newfoundland on special request) and lectured on Search & Seizure on GIT. Pat designed a Major Case Management database in Microsoft Access (used in a number of projects and major investigations).

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Private Business Partnering with Law Enforcement to Combat White Collar Crime
Henry Jensen, Chair, National White Collar Crime Centre of Canada (NW4C)

Mr. Jensen will be talking about the conditions in Canada that have led to the creation of the National White Collar Crime Centre of Canada (NW4C).

Public law enforcement downsized in the l990's and moved specialized resources away from non-violent crime investigation. This created a climate where criminal entrepreneurs took advantage of the vacuum in enforcement and seriously victimized the private sector and the general public. Meanwhile, technology evolved that assisted the criminal entrepreneur to take advantage of borders and jurisdictions and to operate from offshore in many situations.

NW4C was devised as a means to bring public sector and private sector concerns to the same table to develop rapid means of reporting economic crime, to develop shared information bases, to develop and share leading edge means of prevention to educate police, law enforcement agencies and the private sector enabling them to work together.

NW4C is taking on an advocacy role to inform governments about the real nature and extent of the white-collar crime problem, which for the most part is not reported and does not get reflected in the crime statistics of Canada. Without this advocacy role, policy makers conclude incorrectly that there is a decreased white-collar crime problem.

Mr. Jensen will also talk about the links between NW4C, RECOL (Reporting Economic Crime On Line) and PNCC (Phonebusters) explaining how this will benefit the private sector and the public.

Henry Jensen

Henry Jensen enjoyed an extraordinary 37 year career in the Royal Canadian Mounted Police (RCMP). Prior to his retirement in 1989, Mr. Jensen had been Deputy Commissioner, Operations for over eight years. In this position, he was responsible for all aspects of RCMP policing operations, intelligence processes and security activities. His work encompassed economic crime, drug enforcement, organized crime, criminal intelligence, immigration and customs, protective policing including airport policing, national security (terrorism, sabotage, official secrets), foreign services and Interpol. He oversaw the establishment of the Special Emergency Response Team (SERT) to counter terrorist hostage situations. He served on the Security Intelligence Committee, the Security Advisory Committee and participated at the Cabinet Committee on Security and Intelligence. He drafted and concluded cooperation agreements between the RCMP and CSIS.

He served as Commanding Officer in British Columbia where he was responsible for all facets of policing and its administration. Prior to that, he was the founding Director of the Commercial Crime Branch and the program now known as Economic Crime. His earlier service was in the Province of Alberta.

Upon retirement from the RCMP, Mr. Jensen established a consulting business. During this period he served with the Commonwealth Observer Mission to South Africa from 1992-94 in relation to violence and terrorism and was involved in implementing that country's peace process to reduce terrorism and political violence preparing the country for an election. He also served as an election observer on behalf of the Commonwealth.

In 1996, Mr. Jensen joined the firm of Deloitte and Touche LLP as Senior Vice President serving in Financial & Special Services Group (now FAS) with a focus on fraud investigations and security matters.

He has been involved in the creation and development of the National White Collar Crime Centre of Canada and functions as Chairman of the Board of Directors.

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Medical Practitioner Fraud: A Case Study
Deanna Maric, Investigative Consultant, Sun Life Financial

Deanna will walk you through a unique case study outlining the process that lead to the revocation of a Chiropodist's licence. Deanna will detail her experiencesthroughout the investigation including exposing the case, identifying the issues, gathering the data, filing the complaint and testifying at the hearing.

Deanna Maric

Deanna began her insurance career with Mutual Life of Canada in 1993 in the Montreal Group Claims office and then moved to the Infocentre in Waterloo. In both roles, she handled complex issues and client inquiries. In 1997, she moved to the Investigative Services unit where she continues her work in fraud investigations, consulting and training.

Deanna has had many successes with her cases through the criminal court systems and regulatory licensing bodies and in recovering money for clients. Her College and University educations in Abnormal Psychology and Communications intuitively prepared her for this rewarding career.

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Identity Theft & Health Card Fraud
Detective Staff Sergeant Chuck Cox, Ontario Provincial Police
Detective Sergeant Scott James, Ontario Provincial Police

In our society, our identity is the most personal thing we can possess. Our personal identity is something that we work all our life to establish and maintain. Identification identifies who we are, determines the privileges and benefits that we are entitled to, our nationality, place of birth, financial credit that we have established and, in some cases, our position in society. When our identity becomes compromised the effects can be devastating. Identity theft is an emerging crime problem of significant proportions requiring a comprehensive and coordinated approach from all levels of government. Cooperation from those stakeholders involved in law enforcement and the private sector, as well as public education, is of paramount importance to combat this crime. Please join Detective Staff Sergeant Charles Cox, leader of the Ontario Provincial Police, Anti-Rackets Section, Identity Theft Team as he discusses the overall problem of identity theft, its effect on society, how to protect yourself, how it is committed and how it is closely related to health card fraud.

Detective Staff Sergeant Chuck Cox

Detective Staff Sergeant Charles Cox is a 17-year member of the Ontario Provincial Police. He started his career in the Warren detachment and has also worked at the Guelph Detachment and the Provincial Police Academy. For the last seven years, he has worked in the Anti-Rackets Section, Investigation Bureau, which is a specialized unit providing investigative resources to the province in relation to major fraud investigations. Recently, as a result of the growing crime trend of identity theft, Anti-Rackets created a new team to deal with multi-jurisdictional identity theft cases involving situations where government documents have been forged or otherwise obtained in order to perpetrate offences. Detective Staff Sergeant Charles Cox is the leader of the Anti-Rackets Section, Identity Theft Team.

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Proactive Monitoring
Dr. Garry Salisbury, Ontario Ministry of Health & Long-Term Care

Dr. Salisbury will share how the Ministry of Health is developing an exciting new program using newly acquired technology that will allow the early identification and prevention of incorrect/inappropriate claims. Traditional methods of monitoring fee for service claims which involves pre-screening claims by computer rules followed by post-paymentreview is effective. However, preventing incorrect/inappropriate claims is even more effective. Learn more in this informative session.

Dr. Garry Salisbury

Dr. Salisbury, who has a degree in biochemistry, is a Senior Medical Consultant and Manager of the Monitoring and Control section of the Provider Services Branch of the Ministry of Health and Long-Term Care for the province of Ontario. He has worked for the Ministry and Monitoring and Control since 1999 taking over as Manager of the unit in January 2003. Prior to working for the Ministry, Dr. Salisbury spent 20 years as a practicing family practitioner in remote rural and small city environments. He still maintains some clinical activities.

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Health Fraud Investigation Overview & Case Study
Detective Staff Sergeant Dave Ross, Team Leader, Health Fraud Team,
Anti-Rackets Section, Ontario Provincial Police

Dave will present a case study of a recent successful health care fraud investigation. As well, he will provide a profile of the Ontario Provincial Police's Health Fraud Team that operates in partnership with the Ministry of Health and Long Term Care investigating and detering health care fraud in Ontario.

Detective Staff Sergeant Dave Ross

Dave Ross is a Detective Staff Sergeant with the Ontario Provincial Police Anti-Rackets Section and Team Leader of a 28 member multi-disciplinary team of OPP officers that investigate health care fraud under an agreement and in partnership with the Ministry of Health and Long Term Care. Detective Staff Sergeant Ross has 13 years experience investigating criminal offences with the last 6 investigating and case managing major fraud schemes. He is a member of the CHCAA, International Association of Financial Crimes Investigators(IAFCI) and a law enforcement liason to the National Health Care Anti-Fraud Association(NHCAA).

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Case Study: 'Dr. Peter Wilson'
Detective William G. Sheaves, Toronto Police Service, Fraud Squad

This presentation will chronicle the investigation of the case of REGINA VS WILSON by Detective Sheaves and contain the history that led to the conviction and incarceration of Peter Wilson.

Peter Wilson was the director of the Chiropody Department of the University Health Network in Toronto. During his tenure and in the years from 1999 to 2001, Peter Wilson by himself and with others was responsible for the theft of almost $1,000,000.00.

Detective Sheaves will detail the methods used by Mr. Wilson to perpetrate this crime and talk about the resolution for the hospital. He will also present recommendations on how to combat this type of crime.

Detective William G. Sheaves

In January 1974, Detective William Sheaves joined the then Metropolitan Toronto Police Force as a cadet. He became a Constable in January 1975 and was assigned to #5 Traffic where he became a specialized Accident Investigator.

In 1980, he transferred to #31 Division, located in the Jane-Finch area where he primarily was a uniform officer. During that time, Detective Sheaves was appointed to the Criminal Investigative Bureau and then later was assigned to the divisional fraud office for two years.

After he was promoted in September 1988, he was appointed Sergeant and sent to #14 Division in the downtown west of Toronto. During his time there, he was primarily a uniform supervisor but was attached to the Criminal Investigative office for a year. In 1996, he was asked to attend at the Ontario Police College where for 8 months he taught recruits the basics of the Criminal Code.

In August 2000, Detective Sheaves was transferred to the Fraud Squad where he now investigates frauds and is the Squad training officer.

Detective Sheaves has a Bachelor of Arts degree in History.

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Data Profiling
Steve Arnold, Vice President, Pharmacy Systems and Services - US & Canada, NDCHealth
 

Steve Arnold


Health Care Fraud in the United States - Trends, Challenges, Partnerships
Supervisory Special Agent Charlotte A. Lang, Federal Bureau of Investigation
 

Supervisory Special Agent Charlotte A. Lang

Supervisory Special Agent (SSA) Charlotte A. Lang has been with the Federal Bureau of Investigation for 22 years. She has served in the New Haven, San Antonio, New York and Philadelphia FBI field divisions. Prior to her arrival to the Philadelphia Division, SSA Lang served as an Organized Crime (OC) Supervisor at FBI Headquarters in Washington, D.C.

While serving in the New York Division, SSA Lang was the co-case agent of the La Cosa Nostra (LCN) Commission Case, an investigation that resulted in the convictions and life sentences of the entire hierarchy of the New York LCN families. She supervised Philadelphia's OC squad for three and a half years and supervised a case that resulted in the convictions of the hierarchy and 24 members of the John Stanfa OC Family. For the last nine years, SSA Lang has been the Special Agent in Charge of Philadelphia's Health Care Fraud/Insurance Fraud Program. SSA Lang supervised the investigation of the SmithKline Beecham Clinical Laboratories for submitting false claims to the Medicare Program. This investigation realized a civil settlement of $332 million dollars for the United States Government.

SSA Lang is a graduate of Westminster College, New Wilmington, PA. and holds a Master's Degree from the University of Virginia, Charlottesville, VA. Prior to her employment with the FBI, she was a teacher, an Elementary School Principal and a Marketing Representative with IBM.

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Dr. Michael Rachlis, MD MSc FRCPC
Private consultant

Dr. Michael Rachlis graduated from the University of Manitoba medical school in 1975. He interned at McMaster University, after which he practiced family medicine from 1976 to 1984 at the South Riverdale Community Health Centre. He returned to McMaster University in 1984 for a residency in community medicine, which he completed in 1988.

Dr. Rachlis currently works as a private consultant in policy analysis, epidemiology, and program evaluation. His clients include governments and health care organizations. Dr. Rachlis currently works as a private consultant in policy analysis, epidemiology, and program evaluation. He is also an associate professor in the Department of Health Policy, Management, and Evaluation at the University of Toronto. From 1995 to 1998, he was an external member of the Conference of Deputy Ministers Advisory Committee on Population Health.

Dr. Rachlis has lectured widely on health care issues and has been invited to make presentations to committees of the Canadian House of Commons and Senate and the United States House of Representatives and Senate. He is a frequent media commentator on health policy issues, and is the co-author (with Carol Kushner) of two national bestsellers. His third book, Prescription for Excellence: How Innovation is Saving Canada's Health Care System, is scheduled for publication by HarperCollins in February 2004. Dr. Rachlis lives in Toronto with his wife and two children.

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John R. Rudolph
Pfizer Inc.

Dr. John Rudolph is Vice President Legal Affairs, General Counsel and Corporate Secretary to Pfizer Canada Inc. He joined Pfizer in January of 2001, after leaving the partnership at Bereskin & Parr, Toronto's largest Intellectual Property specialty law firm where he specialized in biotechnology and pharmaceutical matters including patents, due diligence, licensing and litigation. Prior to his career in law, John received his B.Sc. and M.Sc. in Physiology from the University of Toronto and a Ph.D in Medical Sciences from McMaster University. He received his Bachelor of Law degree from the University of Ottawa and was called to the Ontario Bar in 1992. John has publications in the scientific and patent sectors and is a frequent lecturer and panelist. He is Chair of the Biotechnology Legislation Committee of the Intellectual Property Institute of Canada (IPIC) and is a member of the Toronto Biotechnology Initiative, the Canadian Association of Corporate Counsel, the Licensing Executives Society and the Canadian Bar Association. John is also a member of the Board of Directors of the West Island Community Shares.

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