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Ontario's Accelerated War Against Medicare Misuse Another Sign Ofleaner Health Care Times

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Ontario's Accelerated War Against Medicare Misuse Another Sign Ofleaner Health Care Times _ l_ __-_- ONTARIO'S ACCELERATED WAR AGAINST MEDICARE MISUSE ANOTHER SIGN OF LEANER HEALTH CARE TIMES Milan Korcok for Ontario residents abroad. Investi- :%:F., .:::: .;::: :::: i:.. ::.::,:;.,.:,. 5, :.... ... E::: gators are still unable to provide a re- liable estimate of the amount spent providing services to unqualified pa- tients living in the province. Before October 1991, when OHIP changed its policy for reim- bursing out-of-country health care providers and dropped its per diem hospital rates to $400 Canadian, the provincial health insurer paid most foreign hospitals the amount they asked for, and the annual bill was about $250 million. Ontario was one of the most generous jurisdictions in the world. Even European countries with comprehensive health care plans generally do not insure nation- als who are travelling in other coun- tries, except for some reciprocal Once a benign cash cow for in November 1994. It is nearing full arrangements within the European American hospitals and free- strength, with eight investigators Community. When visiting North wheeling travellers, the Ontario now stationed across the province. America, European travellers need Health Insurance Plan (OHIP) is All are special constables of the On- private insurance. now using the Criminal Code to tario Provincial Police and are em- Despite the 1991 change in curb the fraud and abuse that has powered to act on search warrants OHIP policy, abuse continued. been draining millions of health care and lay criminal charges against When a former resident of Canada dollars from the province. those suspected of defrauding OHIP. now living near Detroit took her The threat of criminal sanctions Margaret Buffington, manager of trusty OHIP card and crossed the whether against foreigners flying the investigation unit, told CMAJ border to have her baby in a Wind- in to use friends' or relatives' OHIP that the game has indeed turned seri- sor hospital, she was quickly appre- cards, strangers who use misplaced, ous. "Yes, we are cops," she confirms. hended - thanks to a hotline tip stolen or counterfeit cards, or snow- And yes, the Ontario government "is and the cooperation of the Windsor birds who bend residency require- very much behind this [antifraud] police. Wisely, she pleaded guilty; ments to hold on to medicare bene- initiative. This government believes her punishment was simply to make fits is likely to change OHIP's that health care money ... needs to restitution. image as Mr. Nice Guy. be very carefully spent.`" From now on the punishment A key element of its accelerated In fiscal 1994-95, about $74 mil- won't be so soft, especially where the war against health care fraud is an in- lion was spent on out-of-Canada contravention is clearly deliberate vestigation unit that began operating health care for Ontarians: $26 mil- and the intent is to defraud. Such de- lion was for services pre-approved by liberation is much more likely to with it a says Milan Korcok is a freelance writer living in Lauderdale by the the health ministry, and $48 million bring criminal charge, Sea, Florida. was spent providing emergency care Buffington. 554 CAN MED ASSOC J * 15 FCVR. 1996; 154 (4) That message should sound a days per year out of their home and heading south as soon as they warning to the thousands of Ontario province if they want to be consid- close in October. The OHIP umb;li- residents who spend long periods ered residents, and thereby qualify cal cord keeps them returning, but out-of-province each year, taking the for OHIP benefits. only for a couple of months at a time. sun in Florida, Texas, Arizona, Cali- But many do not. Some stretch There are also some who stay fornia and other southern destina- out their 'vacations" to 7 or 8 months away year after year. They manage tions. Most abide by the rule that a year, returning to stay in Canadian motels or restaurants, blend into the they can spend no more than 183 trailer parks after they open in May local society, and return to Ontario CAN MED ASSOC J * FEB. 15, 1996; 154 (4) 555 only for their annual checkup or for than 5000 people. Residency, or the Linda McDade, an appraiser for treatment of serious illnesses that lack of it, was a key factor in many of Pasco County, says that tax officials in would bankrupt them in the US. those cancellations. several Florida counties intend to pur- Working in tandem with the in- Claim of residency can be a two- sue information-sharing agreements vestigation unit, a registration, plan- edged sword. Last year, tax assessors with Canadian provinces. Bogus ning and verification unit is responsi- in central Florida's Pasco County homestead exemptions to foreigners ble for purging the rolls of the levied an $8000 lien against an On- cost the US millions of dollars each unqualified. It has been in place for tario couple they say had gained an year. If the information also helps several years, but clearly has gained unjustified "homestead" tax exemp- agencies such as OHIP identify peo- strength because it can now pass tion for a number of years. The ple who are not true residents and are leads on to sworn investigators. homestead law exempts permanent, cheating their own neighbours, asks Jacqueline Heath, manager of the full-time residents of Florida from the McDade, where's the harm? verification unit, notes that since first $25 000 of the appraised value of Buffington emphasizes that it is OHIP set up a public `tips' hotline at a primary home. The application not OHIP's intent to victimize or in- the end of 1993, there have been makes it crystal clear the exemption timidate seniors or other long-term more than 1000 calls from consumers is not intended for second or vacation travellers who use their out-of-coun- and health care providers conceming homes, or for anyone who doesn't try quotas properly, or who inadver- suspicions or allegations of impropri- have supporting documentation of tently bend the rules. 'There is a dif- ety. More than 900 have been passed permanent residency in the state "to ference between inadvertence and on to the investigation unit for follow- the exclusion" of otherjurisdictions. deliberate intent to defraud," she says. up. (In Ontario, the consumer hotline The assessors called OHIP for When a foreign national flies in to number is 800 268-1 154; for those verification of this couple's status and feast on OHIP's bounty, or a senior calling from outside the province, the were told by an unidentified source retiree or Canadian expatriate returns number is 416 314- 5518.) that the couple was eligible for bene- to Ontario just long enough to claim Heath believes that if the Progres- fits, and therefore must be perma- an address of convenience, there is sive Conservative government con- nent residents of Ontario. They more than inadvertence at work. To- tinues with the photo-identification couldn't be permanent residents of day, such actions may earn a chance system introduced by the former Ontario and Florida at the same to repay the bill, and outright fraud government last February, the mo- time, so Pasco County assessors re- may earn time in jail. mentum against OHIP fraud will in- moved their homestead exemption The inadvertent transgressor tensify. Applicants for new cards and required them to pay back all whose OHIP benefits are cancelled must show original documentation the property tax advantages they had can appeal to the Health Services confirming citizenship status and gained over the years, plus penalties. Appeal Board and seek reinstate- provide proof of residency, and must The couple sued the county, and ment, after re-establishing residency. reregister every 5 years. charged that OHIP had betrayed its But those who attempt to deliber- Ontario doctors were brought mandate to keep medical informa- ately defraud OHIP are guilty of into the fight through Bill 50, which tion confidential. OHIP investigated criminal action, warns Buffington; if mandates them to alert OHIP the "leak" and responded that such convicted, they could end up with a through a special hotline (800 265- information about eligibility was not criminal record. 4230) of their suspicions about pa- confidential, and there had been no Since the investigation unit was tients who may be using OHIP inap- contravention of OHIP policies. The created, approximately 150 cases have propriately. Have they seen the court case continues. been brought to conclusion, and al- patient before? Do individual charac- However, verifications manager though that may not sound like much teristics match up to information in Heath says her staff will operate un- for a year's work, the start-up process the medical file? Might the patient der the presumption that information was tedious. As well, the gathering of be a traveller from another hemi- about residency or OHIP eligibility evidence for criminal cases is more sphere? Is the patient a traveller just is protected. Unless or until memo- burdensome than gathering evidence back in town for a few days before randa of understanding are crafted to cancel health benefits temporarily. heading "home" to Florida? between foreign jurisdictions and "But now," says Buffington, "a According to the health ministry, Ontario, such information will re- number of cases are just at the bub- up to the end of April 1995 the veri- main confidential - even though it bling stage." It's time for those who fication unit had conducted more would certainly be useful to OHIP have been taking the OHIP cash than 9500 eligibility reviews and investigators to know which Ontari- cow for granted to realize that this cancelled OHIP coverage for more ans also claim residency abroad.
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