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Bulletin Number 4328
Distribution
Physicians, Hospitals, Clinics, and Laboratories
Subject OHIP FRAUD REPORTING
In support of the government's "zero tolerance" policy for health fraud, the ministry has implemented a new regulation. Effective April 24, 1998, Regulation 590/94 of the Health Insurance Act was replaced by Regulation 173/98.
Mandatory Reporting
Regulation 590/94 required physicians, certain members of their staff, as well as certain hospital and health facility staff to report, anonymously if preferred, specific incidents of health fraud to the ministry.
With the implementation of Regulation 173/98, the number of prescribed persons who are required to report specific incidents of health fraud is now extended to include:
registered nurses of the extended class (nurse practitioners), midwives, laboratory staff, schedule 5 physiotherapists, dentists, optometrists, podiatrists, chiropractors, and employees of these groups.
Under this new regulation, all prescribed persons listed above are:
required by law to report specific incidents of health fraud, as per subsection 43.1 (1);
permitted to take possession of a health card when it is surrendered voluntarily, per subsection 11.1 (2);
protected from liability when taking possession of a health card, in accordance with subsection 11.1 (4); and,
protected from liability when making a mandatory report of specific incidents of health fraud unless acting maliciously and the information on which the report is based is not true, as per subsection 43.1 (7).
Prescribed persons are required to report specific incidents of health fraud they have knowledge of in the course of their professional or official duties. The specific incidents are:
An ineligible person receives or attempts to receive an insured service as if he or she were an insured person.
An ineligible person obtains or attempts to obtain reimbursement by the Plan for money paid for an insured service as if he or she were an insured person.
An ineligible person, in an application, return or statement made to the Plan or the General Manager, gives false information about his or her residency.
An "ineligible person" means a person who is neither an insured person nor entitled to become one.
Although prescribed persons are not required by law to notify a law enforcement agency, the ministry does encourage prescribed persons to do so when they are reasonably satisfied that fraud or an attempt to defraud the health system has occurred. It is when an individual is committing or attempting to commit fraud that the occurrence can most effectively be addressed.
./2
Office locations
Barrie
30 Poyntz St.
L4M 3P2 Hamilton
119 King St. W
P.O. Box 2280, Stn. A
L8N 4C8 Kenora
220-808 Robertson St.
P9N 1X9 Kingston
1055 Princess St.
P.O. Box 9000
K7L 5A9 Kitchener
Canada Life Square
Main Floor
235 King St. E.,
N2G 4N5
London
217 York St., 5th FloorP.O. Box 5700
Terminal A
N6A 1B7
Mississauga
201 City Centre Dr.
P.O. Box 7020, Stn. A
L5A 3M1 North Bay
101-447 McKeown St.
P1B 9S9 Oshawa
Exec. Tower,
Oshawa Centre.
419 King St. W.
P.O. Box 635 L1H 8L4 Ottawa
Fuller Building
75 Albert Street
K1P 5Y9
Owen Sound
981 2nd Avenue E.
N4K 2H5 Peterborough
550 Lansdowne St. W.
K9J 8J8 St. Catharines
59 Church St
3rd Floor
L2R 3C3
Sarnia
452 Christina St. N.
N7T 5W4 Sault Ste. Marie
Roberta Bondar Place
70 Foster Dr., Ste. 100
P6A 6V4
Sudbury
199 Larch St.,
Suite 801
P3E 5R1
Thunder Bay
435 James St. S. ,
Suite 113
P7E 6T1 Timmins
38 Pine St. N., Ste. 110
P4N 6K6 Toronto
2195 Yonge St.
P.O Box 1700 Stn. A
M5W 1G9 Windsor
1427 Ouellette Ave.
N8X 1K1
Head Office
P.O. Box 38
Kingston, ON
K7L 5J2更多精彩文章及讨论，请光临枫下论坛 rolia.net
Bulletin Number 4328
Distribution
Physicians, Hospitals, Clinics, and Laboratories
Subject OHIP FRAUD REPORTING
In support of the government's "zero tolerance" policy for health fraud, the ministry has implemented a new regulation. Effective April 24, 1998, Regulation 590/94 of the Health Insurance Act was replaced by Regulation 173/98.
Mandatory Reporting
Regulation 590/94 required physicians, certain members of their staff, as well as certain hospital and health facility staff to report, anonymously if preferred, specific incidents of health fraud to the ministry.
With the implementation of Regulation 173/98, the number of prescribed persons who are required to report specific incidents of health fraud is now extended to include:
registered nurses of the extended class (nurse practitioners), midwives, laboratory staff, schedule 5 physiotherapists, dentists, optometrists, podiatrists, chiropractors, and employees of these groups.
Under this new regulation, all prescribed persons listed above are:
required by law to report specific incidents of health fraud, as per subsection 43.1 (1);
permitted to take possession of a health card when it is surrendered voluntarily, per subsection 11.1 (2);
protected from liability when taking possession of a health card, in accordance with subsection 11.1 (4); and,
protected from liability when making a mandatory report of specific incidents of health fraud unless acting maliciously and the information on which the report is based is not true, as per subsection 43.1 (7).
Prescribed persons are required to report specific incidents of health fraud they have knowledge of in the course of their professional or official duties. The specific incidents are:
An ineligible person receives or attempts to receive an insured service as if he or she were an insured person.
An ineligible person obtains or attempts to obtain reimbursement by the Plan for money paid for an insured service as if he or she were an insured person.
An ineligible person, in an application, return or statement made to the Plan or the General Manager, gives false information about his or her residency.
An "ineligible person" means a person who is neither an insured person nor entitled to become one.
Although prescribed persons are not required by law to notify a law enforcement agency, the ministry does encourage prescribed persons to do so when they are reasonably satisfied that fraud or an attempt to defraud the health system has occurred. It is when an individual is committing or attempting to commit fraud that the occurrence can most effectively be addressed.
./2
Office locations
Barrie
30 Poyntz St.
L4M 3P2 Hamilton
119 King St. W
P.O. Box 2280, Stn. A
L8N 4C8 Kenora
220-808 Robertson St.
P9N 1X9 Kingston
1055 Princess St.
P.O. Box 9000
K7L 5A9 Kitchener
Canada Life Square
Main Floor
235 King St. E.,
N2G 4N5
London
217 York St., 5th FloorP.O. Box 5700
Terminal A
N6A 1B7
Mississauga
201 City Centre Dr.
P.O. Box 7020, Stn. A
L5A 3M1 North Bay
101-447 McKeown St.
P1B 9S9 Oshawa
Exec. Tower,
Oshawa Centre.
419 King St. W.
P.O. Box 635 L1H 8L4 Ottawa
Fuller Building
75 Albert Street
K1P 5Y9
Owen Sound
981 2nd Avenue E.
N4K 2H5 Peterborough
550 Lansdowne St. W.
K9J 8J8 St. Catharines
59 Church St
3rd Floor
L2R 3C3
Sarnia
452 Christina St. N.
N7T 5W4 Sault Ste. Marie
Roberta Bondar Place
70 Foster Dr., Ste. 100
P6A 6V4
Sudbury
199 Larch St.,
Suite 801
P3E 5R1
Thunder Bay
435 James St. S. ,
Suite 113
P7E 6T1 Timmins
38 Pine St. N., Ste. 110
P4N 6K6 Toronto
2195 Yonge St.
P.O Box 1700 Stn. A
M5W 1G9 Windsor
1427 Ouellette Ave.
N8X 1K1
Head Office
P.O. Box 38
Kingston, ON
K7L 5J2更多精彩文章及讨论，请光临枫下论坛 rolia.net