Orthotics store, 2 TTC employees bilk Manulife out of $4M+

orthotics-foot

I have had knee and back problems for years. If I didn’t have orthotics at $500+ a pop my shoe wardrobe would be limited to Birkenstocks. I wouldn’t be able to walk very far or exercise. So as you can imagine, I’m thrilled that retiree benefits from the company where I spent most of my career includes reimbursement every two years for 80% of the cost of one pair.

But that’s also why I’m also absolutely furious for a whole bunch of reasons that two TTC employees and an orthotics store (Healthy Fit) have bilked Manulife out of over $4M. That works out to 8,000 pairs of orthotics, more or less. Or cash fares for 2 million seniors at $2 each!

According to a letter issued by TTC CEO Andy Byford to TTC employees, it is alleged that receipts were provided to individuals by Healthy Fit for claim reimbursement where no product or service was obtained or where receipt amounts were inflated. It is further alleged that the health care provider and the person making the claim would then share the money paid out by the TTC’s insurer, Manulife Financial, for these improper and fraudulent claims.

This matter was brought to the TTC’s attention via the Integrity line. The Integrity line allows for information to be provided to TTC investigators, anonymously if the person wishes, for investigation. While Byford notes that there were objections to the “snitch” line when it was implemented two years ago, he says it has proven its value and now it’s here to stay.

Once the TTC became aware of the possible fraud, the company immediately contacted Manulife and they in turn launched their own investigation, which ultimately led to the involvement of the Toronto police. The owner of the store and two employees were charged. Needless to say, claims from other Healthy Fit customers will no longer be paid by insurance companies. However, the investigation continues and to date, no TTC employees have been charged.

I’m furious because benefits fraud costs us all. Employers don’t have to offer employees paramedical benefits and if the costs of these program are unreasonably inflated, they can easily be cancelled or folded into flex plans or Health Spending Accounts which cap benefits like physiotherapy, chiropractics and orthotics at a global annual amount.

I’m mad because we shouldn’t need snitch lines to ferret out corporate fraud. And although the timeline for the fraudulent activity is unclear from media reports, even with the snitch line, why did it take so long to shut this scheme down? Surely a deluge of claims for orthotics purchased at the same store by TTC employees or their families should have set off bells at Manulife sooner.

I’m sad because this happened to a public sector employer providing a necessary service supported by our taxes. This will only serve to reinforce unfortunate stereotypes of inadequate public sector governance and of public servants as “haves” in a world where the majority of private sector employees do not have access to similar benefits.

 

So what can you do about it? Examples of health care fraud include:

  • Phantom claims for services or supplies that were never provided
  • Using someone else’s medical insurance information to obtain services or supplies
  • Falsifying signatures or medical records to support misrepresented services or supplies
  • Misrepresenting the location where services or supplies are provided
  • Rendering medical care without a license
  • Duplicate claim submissions

 

You can protect yourself by:

  • After care, review your explanation of services provided to verify accuracy.
  • Report any discrepancies to your health insurance plan or payer.
  • Beware of “free” medical services, as illicit entities use this lure to obtain information.
  • Safeguard your medicare or insurance card the same as you would your credit card.
  • Report instances where co-payments or deductibles are waived.
  • Don’t give your insurance number to marketers or solicitors.
  • Never sign a blank insurance form.

 

Benefits fraud is not a harmless prank or the subject of a party joke – nudge, nudge, wink, wink. If you are aware of fraudulent activity, you can report it on the website of the Canadian Health Care Anti-Fraud Association.

However, you should be aware that any information you provide will be referred to appropriate CHCAA corporate members, and may result in administrative and/or enforcement activity. It will also be used to identify emerging fraud schemes and trends. If you want to remain anonymous, do not submit any personal information on this form.

 

 

Also read:

TTC benefits used in alleged insurance fraud

$4M fraud scheme targeted TTC employees: police | CTV …

TTC insurance benefits planned bilked of $4M – Toronto Sun

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