CHCAA some health care fraud cases

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www.chcaa.org

Salud y medicina Noticias y política

Some health care fraud
cases

Fraud Cases cont'd

Dr. jailed for trafficking pain
killers


Drug addicts a hit with
Vancouver pharmacy


Fake nurse defrauds insurers


Wanted Canadian doc tracked
to Newcastle, UK.

Some Case Studies

CBC TV Investigative report - dental

A woman from Brampton charged with 234
counts of double doctoring and fraud for
prescription narcotics

A pharmacist charged with obtaining
prescriptions for high priced drugs and paying
the patient a percentage of the total prescription
– not dispensing the meds however billing ON
Gov. for the prescription.

A US citizen charged who was receiving insured
medical services for which he was not entitled

Some Case Studies

Foot care practitioners charged with
submitting fraudulent claims to OHIP

A Pharmacy case – fake Norvasc
medication being dispensed to clients and
the coroner investigating if this
contributed to the deaths of multiple
patients

A Canadian pair who were charged over
their fake Cancer clinic – this affected
over 800 patients in Mexico totaling 12
million dollars

Contact Us

Canadian Health Care
A Anti-fraud Association (CHCAA)

www.chcaa.org
Phone 416-593-2633
e-mail info@chcaa.org

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By Julie Creswell and Reed Abelson Nov. 30, 2012 For decades, doctors in picturesque Boise, Idaho, were part of a tight-knit community, freely referring patients to the specialists or hospitals of their choice and exchanging information about the latest medical treatments. But that began to change a few years ago, when the city’s largest hospital, St. Luke’s Health System, began rapidly buying physician practices all over town, from general practitioners to cardiologists to orthopedic surgeons. Today, Boise is a medical battleground. A little over half of the 1,400 doctors in southwestern Idaho are employed by St. Luke’s or its smaller competitor, St. Alphonsus Regional Medical Center. Many of the independent doctors complain that both hospitals, but especially St. Luke’s, have too much power over every aspect of the medical pipeline, dictating which tests and procedures to perform, how much to charge and which patients to admit. In interviews, they said their referrals from doctors now employed by St. Luke’s had dropped sharply, while patients, in many cases, were paying more there for the same level of treatment. Boise’s experience reflects a growing national trend toward consolidation. Across the country, doctors who sold their practices and signed on as employees have similar criticisms. In lawsuits and interviews, they describe growing pressure to meet the financial goals of their new employers — often by performing unnecessary tests and procedures or by admitting patients who do not need a hospital stay. In Boise, just a few weeks ago, even the hospitals were at war. St. Alphonsus went to court seeking an injunction to stop St. Luke’s from buying another physician practice group, arguing that the hospital’s dominance in the market was enabling it to drive up prices and to demand exclusive or preferential agreements with insurers. The price of a colonoscopy has quadrupled in some instances, and in other cases St. Luke’s charges nearly three times as much for laboratory work as nearby facilities, according to the St. Alphonsus complaint. Federal and state officials have also joined the fray. In one of a handful of similar cases, the Federal Trade Commission and the Idaho attorney general are investigating whether St. Luke’s has become too powerful in Boise, using its newfound leverage to stifle competition. Dr. David C. Pate, chief executive of St. Luke’s, denied the assertions by St. Alphonsus that the hospital’s acquisitions had limited patient choice or always resulted in higher prices. In some cases, Dr. Pate said, services that had been underpriced were raised to reflect market value. St. Luke’s, he argued, is simply embracing the new model of health care, which he predicted would lead over the long term to lower overall costs as fewer unnecessary tests and procedures were performed. Regulators expressed some skepticism about the results, for patients, of rapid consolidation, although the trend is still too new to know fo ...

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2.

3.

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5. Fraud Cases cont'd  Dr. jailed for trafficking pain killers  Drug addicts a hit with Vancouver pharmacy  Fake nurse defrauds insurers  Wanted Canadian doc tracked to Newcastle, UK.

6.

7.

8. Some Case Studies  CBC TV Investigative report - dental  A woman from Brampton charged with 234 counts of double doctoring and fraud for prescription narcotics  A pharmacist charged with obtaining prescriptions for high priced drugs and paying the patient a percentage of the total prescription – not dispensing the meds however billing ON Gov. for the prescription.  A US citizen charged who was receiving insured medical services for which he was not entitled

9. Some Case Studies  Foot care practitioners charged with submitting fraudulent claims to OHIP  A Pharmacy case – fake Norvasc medication being dispensed to clients and the coroner investigating if this contributed to the deaths of multiple patients  A Canadian pair who were charged over their fake Cancer clinic – this affected over 800 patients in Mexico totaling 12 million dollars

10. Contact Us Canadian Health Care A Anti-fraud Association (CHCAA) www.chcaa.org Phone 416-593-2633 e-mail info@chcaa.org