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Journal Article
Medical fraud north of the 49th
2013
Overview
[Joel Alleyne] says it's long been held that between 2% to 10% of every health care dollar in North America is lost to fraud and \"I don't believe it's any less prevalent than it is in the US or in Europe.\" With the Canadian Institute for Health Information projecting outlays in Canada at $207 billion this year, that could translate into upwards of $20 billion per year being funnelled inappropriately into someone's pockets. But a precise breakdown of how much of that is respectively attributable to physicians, or to other health professionals, pharmacies or patients is entirely unknown, as there is no standardized reporting of cases of fraud in Canada or sharing of information between jurisdictions. While there have been cases involving improper billing by a physician, that has typically resulted \"either from misunderstanding of the Rules of Application or liberal interpretation of same\" and has not led to prosecution, [Doug Agnew] adds. There've been \"approximately three or four prosecutions of health care fraud\" and they've been related to the use of a false identity to obtain a medication. There's no way of knowing that, even on a province-by-province basis, [Scott James] says. \"We don't quantify it. We really don't track that. What we know is that there's sufficient work out there for our unit to keep going every year with referrals from the ministry and referrals from other sources to justify the fact that we're here. I think there's a deterrent effect as well when our unit lays charges ... But obviously I don't have that crystal ball to be able to quantify it.\" - Adam Miller, CMAJ
Publisher
Elsevier Inc,Joule Inc,CMA Impact, Inc,Canadian Medical Association
