Bob Thomas - Acting Director, Compliance Branch, WSIB

Bob Thomas, Acting Director, Compliance Branch, WSIB, joined the WSIB in 1998 after enjoying a 22 year career with the RCMP which included 13 years experience with the Commercial Crime Section Fraud Unit, Toronto. Bob conducted investigations as as Senior Investigator with the Special Investigations Branch of the WSIB prior to accepting a position to lead a team of Compliance Specialists. The Compliance Specialist Team is responsible for the WSIB's surveillance program, well as assisting the operating area in seeking voluntary compliance of all workplace parties with the WSIA and conducting intake and analytical work on cases of non-compliance in support of the Investigations and Prosecutions Branch.

Presenting: Red Flags in Disability

This presentation will delve into the common red flags associated with disability fraud and the tools which are being used by the WSIB Compliance Branch to address disability fraud and non-compliance including surveillance, medical management, prosecution and administrative action.

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Brenda Steinnagel - B.Sc.N, M.D., FCFP

Dr. Brenda Steinnagel has worked for WSIB as a medical consultant since 2003, and also run a women's clinic. Dr. Steinnagel graduated from the McMaster B.Sc.N program after having studied kinesiology. She worked for the Hamilton Public Health Department for one year before attending medical school at McMaster, from which she graduated in 1993. She obtained her CCFP in 1996 and has been practicing for 11 years. Dr. Steinnagel has provided medical support for the national trampoline and gymnastics teams, as well as providing medical support for various sporting events including triathalons, marathons etc. She obtained her FCFP in 2007, and is currently preparing to write the CASM exam.

Presenting: Putting Our Foot Down - Orthotics Fraud

This is a two-part presentation. The first will provide an overview of foot orthotic use, misuse and abuse in the current health care delivery environment. The second part will examine strategies for "gatekeepers" (Insurers and Physicians) to assist patients in minimizing their chances of a poor foot orthotic experience.

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Bryan Gast - Ontario Provincial Police

Bryan Gast has been a member of the Ontario Provincial Police since 1995. Prior to that, he started his policing career in 1989 with the Brantford Police Service. He is currently a member of the Health Fraud Investigation Team. The OPP Heath Fraud Investigation Team is responsible for conducting investigations into frauds against the Ministry of Health and Long-Term Care. Bryan has conducted fraud investigations in relation to Optometry, false doctor schemes, pharmacies, and other frauds relating to medical doctors.

Bryan has spent over 11 years in criminal investigations, and has a background investigating major crimes.

Presenting: Seeing Things Clearly - Optometrist Fraud Case Study

This presentation will review the case against an Ontario Optometrist that was charged and convicted of health fraud. The presentation will outline the red flags that triggered the investigation, and how the complaint was presented to the O.P.P. This presentation will also outline the efforts and challenges faced during the investigation and describe how the electronic evidence was prepared for presentation to the courts.

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Francesca Grosso - Author, Health Policy and Communications Expert

Francesca Grosso provides counsel to public and private sector clients that specialize in health care. She has been immersed in health policy and health care communications for more than 12 years, and has provided strategic advice on health care issues to both the federal and Ontario governments.

Grosso worked with Michael Decter to establish the Health Council of Canada after serving as a non-partisan director of policy to the Ontario Minister of Health and Long Term Care. With her team of policy advisors, she helped formulate policy in many files including hospitals, primary care, information management and eHealth, drugs, private clinics, and federal provincial initiatives. Grosso created health policy conferences that brought together Canada's top rated health care policy makers, health economists and political leaders for the purpose of sharing best practices both nationally and internationally.

On the communications side, Grosso co-authored a book with Michael Decter, Navigating Canada's Health Care, A User Guide to the Canadian Health Care System. This book provides help, direction, tips and tricks to help Canadians navigate a complex health care system with better results.

She is also the author of a number of reports, and has created communications strategies and key messages for governments, private and not-for profit-organizations. She co-produced a number of health care videos for governments and not-for-profit clients, and served as vice president of health care at Environics Research Group, where she focused on understanding the gaps in perception between health care providers, policy makers and the general public on the issue of health care delivery.

Grosso lives in Toronto with her husband Steve Paikin and daughter Giulia.

Presenting: General Session

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Gordon Atherley - MD, LLD(hc) - Principal, Greyhead Associates

Gordon Atherley holds the British equivalent of the Canadian PhD and MD degrees, and LLD, Honoris Causa, from Canada's Simon Fraser University. His awards include Officer (Brother) of the Most Venerable Order of The Hospital of St John of Jerusalem, and Fellow of the Royal Society of Arts, UK. His medical specialties are occupational medicine and public health. He is retired from medical practice. He is the developer of PowerBase.Tx, a knowledge management application in current use in healthcare.

He was first President and Chief Executive Officer (rank of Deputy Minister) of the Canadian Centre for Occupational Health and Safety (CCOHS), the Canadian equivalent of the US National Institute of Occupational Safety and Health (NIOSH).

In academia, he held senior, tenured, full-time positions, including chair, in university faculties of physics, engineering, and medicine. In Canada, he was full professor, occupational medicine, at the University of Toronto. He is the author of a textbook and has 50 refereed publications in indexed journals.

He is a life member of the Canadian Medical Association and the Ontario Medical Association, and a reviewer for the Canadian Medical Association Journal. He is a member of the Canadian Committee for Patient Accessible Health Records, among other involvements with information technology for healthcare.

Presenting: Inappropriate Prescribing: Appropriate and Inappropriate Solutions

Duality dominates almost all aspects of drugs and addictions. In this session, Gordon Atherley examines the broad picture of concerns, highlights and positions:

  • Information technology can help detect doctor-hopping, typical of prescription harvesting, but problems in controlling access to data systems create concerns about destinations for data that flows beyond the circle of care.
  • Persons with addictions steal data from healthcare information systems and sell it to create the money they need to buy their drugs.
  • Internet pharmacy supports the supply of addictive medications with ill-enforced requirements for valid prescriptions, yet the drugs actually delivered may be ineffective counterfeits.

The solution: Appropriate communications.

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Howard Platnick - MD

Dr. Howard Platnick graduated from the University of Toronto and is a family physician with a full-time practice in Willowdale, Ontario. He is on active staff at North York General Hospital Department of Family and Community Medicine. He has special interest and focus in disability management and musculoskeletal, neurological, and orthopaedic assessment and treatment. Dr. Platnick is the Medical Director at North York Rehabilitation Centre and is involved in developing policies and procedures for the company. Dr. Platnick works as a medical consultant and assessor at different disability management companies assessing accident benefit claims, WSIB, and short-term and long-term disability. Dr. Platnick works in occupational health and works with Sealy Canada assisting both the worker and Human Resource Department in resolving disability issues.

Presenting: Fraud and the Primary Care Physician

This session will discuss the role of the primary care physician (family physician and GP) and fraud at the office level. Will discuss formal examination/assessment for medicolegal and insurance industry. Focus on review of records and past health and its importance. Review of red, yellow, black, and blue "flags".

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Ian Scott - PhD, VP - Angoss Software Corporation

Dr. Ian Scott (Ph.D. Harvard; B.Sc. McGill) is the VP Consulting for North America and is responsible for the Angoss Consulting organization in North America. In this role, he has grown the Angoss Consulting team to being one of Canada's largest analytics teams, specializing in providing innovative solutions to complex business problems and moving data mining beyond model building to actionable results.

Dr. Scott has over 20 years of experience in delivering analytics, in both private and academic contexts. Dr. Scott has provided data mining solutions to financial services, insurance and telecom clients, using his extensive analytics experience to deliver analytical solutions in sales, marketing, and risk. One of his primary activities is delivering sales optimization solutions in the business to business context for financial services and telecommunications sectors. Dr. Scott spearheaded the development of the FundGUARD™ solution, which has been deployed at several large global mutual fund companies, delivering over a billion dollars in net new mutual fund sales. Another focus area for Dr. Scott has also been the launch of ClaimGUARD™, an insurance claims and payment analytics solution that has already been successfully deployed at a major North American benefits provider.

Prior to joining Angoss, Dr. Scott conducted quantitative risk assessment for UBS. During his academic career he was a faculty member at the University of Wisconsin, Madison. He also held research positions at the CERN Nuclear Research Facility (Switzerland), and at the Stanford Linear Accelerator Facility (California).

Presenting: The Next Worst Thing: Uncovering Emerging Fraud Patterns

The issue with most fraud detection systems is that they are not very good at identifying new patterns of fraud and abuse. This is because they are typically based on rules derived from experience, and more often then not derived from the industry as a whole. If a pattern is new or if it is particular to your company, then these systems will fail to pick it up until the problem is large enough to be easily noticeable.

What is often most surprising is that with the right approach, these patterns can be uncovered in your own data. In his presentation, Dr. Scott will present the solution to this problem, which involves learning from your own data using an unbiased and automatic approach to fraud detection.

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James T. Reese - Ph.D., FAAETS, DPCP, BCSM

Dr. James T. Reese is an internationally known award-winning author, lecturer, and consultant in the specialty areas of stress management, leadership, violence, criminal profiling, and related topics. He served as a platoon leader in Vietnam earning the Vietnamese Police Distinguished Service Cross and the U.S. Bronze Star Medal. He retired from the FBI after serving 25 years as a Supervisory Special Agent. After working in New York and Massachusetts, he served as Assistant Unit Chief of the FBI's Behavioral Science Unit (Silence of the Lambs) and as adjunct faculty in criminology and psychology with the University of Virginia for 18 years. Dr. Reese was one of the founders of the National Center for the Analysis of Violent Crime, the Violent Criminal Apprehension Program, and was an original FBI criminal personality profiler. He helped establish the stress program in the FBI as well as the Employee Assistance Program and the Chaplains' Program. He published seven books while in the FBI. He has been listed in the National Registry of Experts and the Yearbook of Authorities, Experts, and Spokespersons. Dr. Reese has addressed representatives of more than 350 Fortune 500 companies, to include the NFL. He has provided expert testimony before the United States Congress on stress; lectured before the President of the United States' Council on Integrity and Efficiency; and recently spoke before all Inspectors General of the United States at the United States Naval Academy. Dr. Reese consults with faculty members at Johns Hopkins University, The University of Medicine and Dentistry of New Jersey, The Harvard Associates in Police Science, The Saybrook Institute, The University of Virginia and others. He is a Board Certified Expert in Traumatic Stress, Forensic Traumatology, School Crisis Response, Emergency Crisis Response, Domestic Violence, Stress Management and Acute Traumatic Stress Management. He is a Fellow of the American Academy of Experts in Traumatic Stress, a member of their Board of Scientific and Professional Advisors; a diplomat of the Society for Police and Criminal Psychology; and recipient of the FBI Director's Award for Distinguished Service. Dr. Reese has counseled and consulted with the rescuers and others following TWA 800, Swiss Air 111, Pan Am 103, The World Trade Center, The Pentagon, New Orleans "Katrina", and others. He has presented to the National Executive Institute, the International Association of Chiefs of Police, The Canadian Police Association, and more. He is CEO of James T. Reese and Associates, a Virginia based international behavioral sciences and management consulting firm with headquarters in Colonial Williamsburg, Virginia.

Presenting: Coping with Change and Adversity: Staying Bitter or Getting Better™

This year's Keynote Address provides an examination of the uniqueness of stress experienced by individuals in today's marketplace. Fewer people, less equipment, less support, lower budgets, and a demanding work environment creates a theater in which we are asked to continue to act with dignity and surety and dedicate ourselves to the success of our business, while balancing our personal lives. There are proven ways to address these issues, to move forward, and create a sense of personal well-being while doing an outstanding job. It is virtually impossible to excel in today's world without a knowledge of the ways in which the world has changed and the advantages of proper stress management. Employees, and leaders of those employees, are being asked to work more diligently than ever; to accept additional tasks that will allow them to succeed; to be ever mindful of competition; to do more with less; and to be supportive of each other. One of the most difficult concepts to understand as we continue our progress into the twenty-first century is `change'. Change alone has caused more problems in organizations, as well as in the day-to-day lives of individuals, than any other issue. It is time to ask the question: "Is my job a passion, or just a pension?" "Do I want to stay bitter or get better?"

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Jane Kinney - CA, Partner - Deloitte

Jane Kinney is a Partner in the Risk Consulting and Regulatory Services group of Deloitte in Toronto and leads the Canadian practice. Jane is a recognized leader in Risk Management with over 20 years of experience and is a leader in providing services to the Financial Institutions sector. Jane is a frequent speaker at Risk Management conferences in Canada. Jane is a Chartered Accountant, a member of the Canadian Institute of Chartered Accountants and is a graduate of the University of Waterloo.

Presenting: On Guard Against Fraud - Fraud Risk Management Strategies

Organizations can't afford to not be concerned about the risk of fraud. An effective approach to deterring, detecting and preventing fraud starts with a plan. This presentation will cover the development of risk management strategies, as well as risk identification and assessment.

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Jeff Alcock - Manulife, Past CHCAA Chair

Jeff Alcock, HBA, of Manulife Financial was elected as CHCAA's Chair for 2006. Jeff is the Manager of Investigative Services for Manulife Financial Group Benefits. He is responsible for leading a team of experts comprised of investigators, claims analysts, and industry consultants working to at the forefront of Manulife's efforts to protect group benefits plans from the harmful effects of fraud and abuse. Jeff is a graduate of Wilfrid Laurier University in Waterloo and is an Associate member of the Association of Certified Fraud Examiners and the National Health Care Anti-Fraud Association in the United States. He served on the board of the CHCAA for three years prior to becoming Chair.

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Jim Gorry - Ontario Provincial Police, Anti-Rackets Section

Detective Sergeant Jim Gorry began his career in policing in 1982 with the Metropolitan Toronto Police Service. During his career with the Metropolitan Toronto Police he was assigned to various investigative units ranging from Major Crime Units/Plainclothes units. In 1988 Jim was assigned to number 5 District Drug Squad.

In 1994 Jim joined the OPP and was assigned to the South Frontenac Detachment in uniform. In 1996 Jim was assigned to the Kingston Crime Unit and in 1997 was assigned to the Drug Enforcement Section in Kingston. In 2001 Jim was promoted to the D/Sgt and was assigned to the Identity Theft and Forgery Investigation Unit. Since February 2007 Jim has been assigned as the Acting Operations Manager in the OPP Anti-Rackets Section.

Presenting: Just the Facts - Making Your Case To Law Enforcement

Long gone are the days when a company could file a report of fraud and expect police to gather the evidence to prosecute. Filing a brief or report is only the first step as the police will assess the contents of the report as part of the intake process and decision to investigate.

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Jim Makris - Detective Constable, Toronto Police Service

Jim Makris has been employed with the Toronto Police Service since 1982 and has worked in various investigative capacities (Detective Offices, Homicide Squad, Fraud Squad) for the past twenty (20) years. He has been with the Fraud Squad for the past nine (9) years, both as a corporate investigator and currently as an Intake Officer.

Presenting: Just the Facts - Making Your Case To Law Enforcement

Long gone are the days when a company could file a report of fraud and expect police to gather the evidence to prosecute. Filing a brief or report is only the first step as the police will assess the contents of the report as part of the intake process and decision to investigate.

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Joel Alleyne - Executive Director, Canadian Health Care Anti-fraud Association

Mr. Alleyne has worked with management in several organizations. His work has included work with Senior Executives on Business and Organizational Strategy as well as Strategic Information and Technology Planning.

Over the years, Mr. Alleyne has worked with electronic commerce in the insurance and health care industries in Canada and the United States. He has been involved with Canadian initiatives to implements and leverage electronic commerce and new media as well as the development of commercial claims systems products.

Joel has worked with organizations across North America and the Caribbean and is a recognized expert in electronic commerce and new media - and related issues such as privacy, security, confidentiality and fraud.

He is actively involved in research in the area of Information Technology and Organizational Change, New Media and Electronic Commerce. He is an active participant and research assistant with the McLuhan Center for Culture and Technology at the University of Toronto. A grad student with the Faculty of Information Studies and the Knowledge Media Design Institute, University of Toronto. As well, he is a faculty member with the Kaieteur Institute for Knowledge Management.

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Kevin Donovan - Toronto Star

Kevin Donovan is the Investigative Editor and a senior reporter at the Toronto Star. Over the past 22 years he has probed wrongdoing in government, police forces, social service groups and many other areas - many of the stories have resulted in significant changes to public policy and/or legislation. His work has earned him three National Newspaper Awards, the Governor General's Award for Public Service Journalism; and other honours. Along the way, he has covered wars in Iraq and Afghanistan. Mr. Donovan has had a particular interest in the area of health care and drug addiction over the past year, with an investigation into the provincial methadone program that resulted in significant tightening in controls over how doctors and pharmacists use the program.

Presenting: Addiction Centres

The treatment of people addicted to drugs in Ontario provided a window into everything that is right and wrong about health care in Ontario. Through the Toronto Star's investigation of the methadone program the public learned that provincial healthcare dollars can be easily abused.

In my presentation, I will delve into the following:

  • the OHIP billing codes - license to steal
  • how the pharmacy and doctors regulatory colleges only acted in face of public pressure
  • How police officers can do their job - and be let down by weak prosecution
  • The patients caught in the middle - how they can be taken advantage of

I will give an overview of the stories we published and give insight into how we got some of the information.

Finally, I will give a prescription for how the system could deal with this type of issue better in the future.

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Leslie Trotter - BSc, DC, MBA, CPed(C), MSc.

Dr. Trotter is a 1990 graduate of Canadian Memorial Chiropractic College who also completed the three-year Sports Fellowship Programme. She certified as a pedorthist in 1995 and has since operated a foot orthotic laboratory. Obtaining an MBA from WLU in 1997 has provided opportunity for her to consult for a variety of companies in the foot orthotic and knee bracing industry, including several insurance companies in the area of orthotic claims and auditing orthotic laboratories. She recently completed a Master of Science degree from McMaster University specializing in foot orthoses and changes in gait efficiency.

Dr. Trotter co-owns a multidisciplinary facility, the Foot-Knee-Back Clinic, in Ancaster, Ontario and will be continuing research on foot orthoses.

Presenting: Putting Our Foot Down - Orthotics Fraud

This is a two-part presentation. The first will provide an overview of foot orthotic use, misuse and abuse in the current health care delivery environment. The second part will examine strategies for "gatekeepers" (Insurers and Physicians) to assist patients in minimizing their chances of a poor foot orthotic experience.

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Michael Decter - Author, Leading Health Care Authority

Michael B. Decter is a Harvard trained economist with over two decades of experience as a senior manager. He is a leading Canadian expert on health systems, with a wealth of international experience.

As a senior manager in the public sector, Michael served as Deputy Minister of Health for Ontario with responsibility for the management of the Ontario health system serving all residents of the province. He also served as Cabinet Secretary in the Government of Manitoba.

As a Senior Research Scholar at the Centre for Bioethics, University of Toronto, Michael Decter authored the book: Healing Medicare: Managing Health System Change The Canadian Way, published in 1994. His second health book, Four Strong Winds: Understanding the Growing Challenges to Health Care, was published in June 2000. His third book, Navigating Canada's Health Care, co-authored by Francesca Grosso, was published in December 2006.

Michael Decter remains active as a public speaker and writer on issues of health reform. He serves as President and Chief Executive Officer of the investment management firm, Lawrence Decter Investment Counsel Inc.

Michael served as the Founding Chair of the Health Council of Canada. He also served for six years as the Chair of the Canadian Institute for Health Information. Michael is the Chair of St. Elizabeth Healthcare, the Ontario Cancer Quality Council, and is now the Chair of the Wait Times Data Certification Council of Ontario. Michael is also a Board member of the National Cancer Institute of Canada, the National Ballet of Canada and the Walrus Foundation. He serves as a member of the Advisory Council to the School of Public Policy at Queen's University and the Advisory Council to the Faculty of Arts and Contemporary Studies at Ryerson University.

In 2004, Michael was awarded The Order of Canada.

Presenting: General Session

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Michael Whitt - Partner, Borden Ladner Gervais

Michael Whitt is a partner in the Calgary office of Borden Ladner Gervais. He graduated from the University of British Columbia Law School in 1978 and was called to the Alberta Bar in 1979. Prior to that, Mr. Whitt received a B.A. from the University of Calgary. Mr. Whitt is a lawyer, Patent Agent and Trade-mark Agent.

Mr. Whitt is Co-Chair of the Calgary BLG Intellectual Property and Technology Department and heads Calgary's informal multi-disciplinary "Technology Law Group". Mr. Whitt also serves on several important functional committees for BLG, including as a member of the firm's Privacy Committee, the Information Technology Steering Committee and the Excellent Knowledge Management Committee, as well as having served regionally on Regional Marketing and Associate Committees.

Presenting: General Session

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Murray Rowe, Jr. - President, Forrest Green

Presenting: Responding to Change: Embracing Technology as an Enabler

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Nicole Homick - CA, Senior Manager - Deloitte

Nicole Homick is a Senior Manager in the Risk Consulting and Regulatory Services group of Deloitte in Toronto. Nicole specializes in working with financial institutions and assisting them in identifying, assessing and mitigating risks within their organization. Nicole is a Certified Management Accountant, a member of the Society of Management Accountants of Ontario and is a graduate of the University of Waterloo.

Presenting: On Guard Against Fraud - Fraud Risk Management Strategies

Organizations can't afford to not be concerned about the risk of fraud. An effective approach to deterring, detecting and preventing fraud starts with a plan. This presentation will cover the development of risk management strategies, as well as risk identification and assessment.

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Rick Beyers - DDS

Dr. Rick Beyers graduated from the University of Toronto in 1966 with a DDS degree. He began practice the same year in Kitchener, Ontario, and continues to practice today. He won the Canadian Dental Association Award of Merit in 1995 for service to the Profession at the local, provincial and national level. He served nine years as a member of the Royal College of Dental Surgeons in Ontario, including three years as its president. In 2005 he sold his Dental office but continues to practice part time as an associate. He also provides consulting services to third party administrators for matters related to dental practice and dental procedures. He is President of the Canadian Association of Dental consultants (CADC).

Presenting: Dental Check-up - Update

This session will examine: patient "wants" - white, straight teeth; practice trends; "the business of Dentistry" including marketing, advertising, and cosmetics; the "wiz-bang" of new technologies - digital devices for everything; and the dilemma of outdated dental benefit plans that encourage abuse (including fraud) and collusion between providers and plan members to "put it all on the form".

The learning objective of the session is to understand that dental procedures with little or no value are a kind of fraud because they consume money that could be spent on services that patients want and need.

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Robert Whitman - Insurance Bureau of Canada

Mr. Robert Whitman is currently the National Director of the Insurance Bureau of Canada- Injury Rings Investigative Unit that specializes in 'staged accident, and organized crime ring fraud groups.' Prior to joining with IBC Mr Whitman worked for Progressive Insurance and Citadel Assurance of Canada where he was exposed to accidents benefits issues from an adjusting and SIU perspective.

As past Regional Director of the International Association of Auto Theft Investigators, and a member of the Canadian Association of Special Investigation Units, and International Association of Financial Crime Investigators he understands the frustration and challenges met by the insurance industry and police agencies in the fight against fraud.

Mr. Whitman's previous career as a police officer with the Toronto Police Service, and York Regional Police Force spanning three decades of criminal investigation handling welfare fraud, credit card fraud, and organized crime has provided a unique perspective on Organized Crime Groups and Staged Accident Fraud. He is committed to raising the national awareness or organized crime and staged accident fraud as it affects health and insurance providers.

Presenting: Provider ID Theft - Will the Real Provider Please Stand Up?

Mr. Whitman's presentation on Provider ID Theft to conference delegates will highlight: the growing trend of identity theft in injury claims; common types of identity theft; the consequences of this type of crime for Registered Health Practioners (RHP), and its impact on the insurance/health care industries. It will also include identity theft prevention tips for RHPs, coupled with an overview of IBC and its role in identity theft and insurance crime prevention, and its advocacy for tougher sentences for perpetrators of this type of crime.

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Robert Zensner - Sergeant, Waterloo Regional Police Service

Sergeant Robert Zensner is fraud detective with the Waterloo Regional Police Service. He has been with the Waterloo Regional Police Service for 18 years.

Robert is a Certified Fraud Examiner, Certified Anti-Money Laundering Specialist, Certified Financial Crime Investigator and a Certified Forensic Investigator.

He has presented at the Association of Certified Fraud Examiner's Conference, the Canadian Police College and the Ontario Police College on fraud related topics.

Robert teaches a fraud investigation course at Conestoga College.

Presenting: Just the Facts - Making Your Case To Law Enforcement

Long gone are the days when a company could file a report of fraud and expect police to gather the evidence to prosecute. Filing a brief or report is only the first step as the police will assess the contents of the report as part of the intake process and decision to investigate.

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Scott Moore - CHCAA Chair; Ontario Provincial Police

Scott Moore has been a member of the Ontario Provincial Police for over 18 years, and is one of the original members of the Health Fraud Investigation Team, which was formed by the OPP 8 years ago. The OPP Heath Fraud Investigation Team is responsible for conducting investigations into frauds against the Ministry of Health and Long-Term Care, as well as working with many other partners in our fight against Health Care Fraud. Scott has conducted fraud investigations in relation to Psychotherapy, Diagnostic Imagery, and Pharmacies, as well as provided advice on many other types of practitioner frauds. Scott currently manages officers in two areas of the Teams' business - User Fraud Investigations and Drug Diversion Investigations.

Scott is fully trained as a Forensic Computer Analyst. He has experience in forensic analyses of PC and Macintosh systems, e-mail threats, and Internet investigations.

Scott has spent over 14 years in criminal investigations, and has a background in fraud, homicide, drugs, surveillance and undercover operations.

Scott is the current (2007) Chair of the CHCAA. In the past, Scott has presented several times at the CHCAA Annual Conference, as well as at the 2002 Toronto Police Service Annual Fraud Conference. Scott also presented in 2005 at the 3rd Annual International Conference on Identity Theft.

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Shawn Cruise - Public Sector Manager, Adobe Canada

Shawn Cruise, Public Sector Manager, Adobe Canada has been working with the Ontario Homicide Investigators Association, OACP, OPP, Toronto Police Service, RCMP, Ministry of the Attorney General (BC and Ontario), Hamilton Police Service, the FBINAA and many other agencies on electronic disclosure and electronic document management initiatives for 3 years. These efforts have led to major improvements in case management and adoption of e-Disclosure Techniques and best practices across Canada and internationally. Mr. Cruise has over 15 years of technology and business solution expertise in the software industry with Adobe Systems, Computer Associates, and Netmanage.

Presenting: Developing a Paper Document and Forms Strategy That Reduces Opportunity for Fraud While Improving User Experience

Organizations continue to struggle with the competing interests of providing users a high level of service and user experience against the need for security to combat fraud. Developing a strategy that provides maximum security while maintaining minimal disruption or complications to users is complicated and often is not cost effective. This presentation will review how developing an internal maturity model for the management of paper and forms can provide an excellent balance for both critical business requirements.

Presenting: E is for Disclosure - Merits of e-Document Management

This presentation will review some of the efforts and challenges of law enforcement and investigative agencies across Canada relating to electronic disclosure. A discussion on eliminating the hard costs, improving the simplicity of use and adoption, as well as the acceptance by the justice system of new and emerging technologies will all provide an educational foundation for the potential adoption of standardized disclosure and more effective paper management across the country.

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Sunny Loo - Director, IT and eHealth, Ontario Pharmacists' Association

Sunny Loo was appointed Director of Information Technology and e-Health for the Ontario Pharmacists' Association (OPA) in September 2006. He is responsible for the adoption of technologies and innovation into OPA infrastructure, informing and educating Ontario pharmacists on their role in the e-health environment, supporting initiatives that would further Ontario pharmacists' role in ehealth, and ensuring, through representation with key stakeholders, a recognition of Ontario pharmacists' role in ehealth.

Prior to joining OPA, Sunny was co-founder and Principal at Pharmacy Access Solutions. He played a key role in Pharmacy Relations & Data Analytics, and in the conception and development of the company's innovative core technology.

Prior to this, Sunny worked as consultant developing innovative and unique processes to address a wide range of strategic initiatives for clients in the Pharmaceutical and Biotechnology industries. His list of accomplishments include the launch of a patient trial program considered the first to allow seamless pharmaceutical company payment to pharmacies; a unique physician sampling process for a prescription narcotic product; and a reimbursement support process specifically for Section 8 assistance.

Sunny is an alumni of the University of British Columbia, faculty of Pharmaceutical Sciences. He is certified as Project Management Professional (PMP). He serves as a member of the Ontario Health Informatics and Standards Council. He is a member of the Ontario Pharmacists' Association, BC Pharmacists Association, College of Pharmacists of BC, Project Management Institute, and the Ontario Pharmaceutical Marketing Association.

Presenting: Inappropriate Prescribing: Appropriate and Inappropriate Solutions

Duality dominates almost all aspects of drugs and addictions. In this session, Sunny Loo describes the broad picture of concerns, with highlights and data:

  • Danger of addiction requires certain drugs to be supplied only on a physician's prescription, but all too often physicians' prescriptions lead to or support addictions to the very same drugs.
  • A drug that's clinically essential in one context can be addictive or even illegal in another.
  • One dangerous drug can be used successfully to combat addiction to others.

The solution: The pharmacist's evolving role.

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The Campbell Brothers - [website]

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Tim Daciuk - SPSS Inc.

Tim Daciuk is currently a Senior Consultant with SPSS . Tim Daciuk has worked with SPSS Inc for 10 years, and with SPSS software for over 25 years. Tim started out working with SPSS software in 1980 during his undergraduate studies at the University of Toronto.

Tim's role with SPSS involves assisting in sales, training and consulting for SPSS, both in Canada and in the United States. In training, Tim has developed courses for SPSS as well as teaching SPSS and related product courses in North America, Europe, and Asia. In consulting, Tim has worked with a number of SPSS clients in North America developing customized applications of SPSS to meet their data analysis requirements.

Tim is also a speaker for SPSS. Tim has presented papers and lead discussions on SPSS, data mining, data analytics, etc., at a number of conferences, workshops and professional gatherings across North America and in the United Kingdom.

Previous to working with SPSS, Tim worked in consulting, primarily involved in survey development, deployment and analysis for both the University of Toronto, and a private firm. Tim has worked as Manager of a computing facility at a college in Toronto. Tim has also taught statistics, research methods and data analysis at the post secondary level.

Presenting: Finding the Fraudulent Needle in the Claims Haystack: Data Mining and Fraud Detection

Finding the needle in the haystack is an ancient quip with new meaning. Successful health care fraud depends upon perpetrators hiding in the large number and large dollar world of claims. As part of the solution, there are a number of technical solutions available to combat fraud, waste and abuse. This presentation will discuss real world strategies used by government and commercial agencies around the world to try and solve this problem.

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Wendy Woods - Watershed Training Solutions

Wendy Woods delivers networking presentations and workshops throughout Ontario. She specializes in such critical workplace skills as effective communication, networking and teamwork. She has an honours B.A. from the University of Western Ontario, an M.B.A. from the University of Toronto and a certificate in Adult Education from St. Francis Xavier University. She is also a certified laughter yoga professional and runs the midtown Toronto Laughter yoga club. Her clients include Bombardier, Johnson & Johnson Inc.,and TD Bank Financial Group.

Presenting: Speed Networking

Speed networking is a networking session with an accelerated twist. This session gives you the opportunity to meet and network with many participants in just over an hour. You will meet more people, make more contacts, and develop more synergies than you ever thought possible in a short period of time.

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William Hiltz - Forensic Consultant, prosperident

William R. (Bill) Hiltz is a senior advisor with prosperident, a Halifax-based management consulting firm with clients from across Canada and the US specializing in providing assistance in tax planning, practice transition, dental economics, fraud prevention and detection to dentists and dental practices.

Bill brings over 15 years experience in practice management consulting to prosperident. Prior to joining the firm, Bill was a senior administrative manager for a public post secondary educational institution and headed his own consulting firm.

Bill serves as an advisory board member for the Order of Privacy Officers and is a frequent lecturer; particularly in the areas of dental fraud, records security and confidentiality.

Bill holds a diploma in applied technology from the Marine Institute, a Bachelor of Science (AdvMaj) and Masters of Business Administration from Dalhousie. In addition to these degrees, Bill is a Certified Engineering Technologist with in-depth experience with computer technology.

Presenting: Fraud Inside the Dental Office

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