Physicians pay for health-card fraud

Canadian Medical Association Journal 1996; 155: 368
In the article "Successive Ontario governments forced to grapple with problem of health care fraud" (CMAJ 1996; 154: 1412-4 [full text / en bref]), Albert Shu argues that the Ontario government should be doing more to protect itself and the people of Ontario against health care fraud.

Why should the Ontario government do more to protect itself? It is completely protected. It pays the physicians of Ontario a fixed amount based on most of the costs of providing health care services in a base year 2 or 3 years ago. This is called the global budget. No matter how many interlopers use fraudulent health cards, and no matter how many times this happens, it costs the taxpayers of Ontario absolutely nothing. The entire amount that the government pays to Ontario physicians for health care that exceeds the global budget is extracted from the physicians in future months.

Ontario physicians have no means of protecting themselves against fraud, yet they are expected to pay the total cost. From the point of view of the government, could any scheme be more fool-proof? Could any scheme be more Machiavellian?

Wallace Troup, MD, FRCPC
University of Ottawa Heart Institute
Ottawa, Ont.


| CMAJ August 15, 1996 (vol 155, no 4) |