Back to All

REP 4 - Organized crime in rehab? Surely this can’t happen in Canada!

Anonymous

By: A concerned physiotherapist

 

Organized crime is not something I ponder frequently. But if my mind goes there, I think about drug deals, guns and Hollywood mob movies.  

It wouldn’t really cross my mind to think about staged car accidents, fake injuries and rehabilitation clinics. 

However, recent investigations in Ontario, British Columbia and Manitoba have uncovered just those kinds of situations.

 

The scam

A quick Google search led me to a series of articles outlining these scams.  

An organizer scours junk yards for luxury brand cars, does some cosmetic repairs and has them insured at above market value. 

They then pay people to be passengers in these cars, and stage a car accident. 

Then the organizer collects the insurance on the cars, the passengers claim bodily harm, and a rehab clinic bills the insurance company for treatments they never provided.  

The web of people involved in these scams is vast--and can even include police officers, insurance appraisers, paralegals, rehab professionals and clinic owners, amongst others. 

A Toronto investigation uncovered a web of over 40 ‘accidents’, totalling more than $10 million in insurance fraud.

There is no question that this is a growing trend in illegal and fraudulent activity.  Sometimes these so-called ‘white-collar crimes’ are thought of as victimless, but that’s not true.  

 

The victims

Although the insurance companies expect and plan for some fraudulent activity, they and their shareholders are still victims of this crime.  

I would also contend that anyone with car insurance is a victim too.  As the cost of fraud and its investigations go up, so do our insurance premiums.  

I challenge you to look at your car insurance costs for the past 10 years--are the rates going down?

 

How the scam affects our profession

Reading these articles was an eye-opener for me.  Once I got over the shock of how devious people can be, it made me think of the reputation of our profession.  

If false claims for physiotherapy and other rehabilitation services are being submitted, how does a member of the public, reading the newspaper, know that the rehab professionals or clinic owners involved are in the minority?  

Who can reassure them that, as a whole, physiotherapy professionals behave ethically – and that these incidents are simply the results of a few bad actors?  

 

What is in place to protect my reputation as a physiotherapist?

In at least one of the cases, rehabilitation services were being billed by providers who have never, or no longer, work for the clinic in question. 

Our provincial colleges always warn us about ‘protecting’ our billing number. But this can be difficult to do, especially if we leave one clinic and begin to work for another. 

It is important to audit the invoices that your clinic sends in on your behalf, and to report any irregularities as soon as you see them.

The auto insurance industry in Ontario has taken an additional step in helping health professionals protect their professional identity.  They have created a system called “Health Claims for Auto Insurance” (HCAI) that allows health care providers, like physiotherapists, to check and see which clinics are using their registration number to submit claims. 

If you see your name associated with a clinic other than where you work, you should notify HCAI at their website, immediately

 

Where do we go from here (please share your ideas below)

Thanks to CPA for starting this important conversation.  We need to have difficult conversations like this in our profession.  

Do we want more regulation or better self-policing?

If we choose the latter, we need to be prepared to call out bad behaviour when we see the actions of others that aren’t consistent with our standards of practice and Code of Ethics.

 

What do you think?

  1. Did you even know that there are scams like this that happen in Canada?
  2. What should be done to prevent organized crime in physiotherapy?
  3. Do we need more regulation or better self-policing?

 

 

 

#30REPS 2017 is brought to you by

 

Read more 30 REPS

 

 

Comments

This has been going on for years. It is even easier because of technology.It would be naive to think that we could protect ourselves fully.

Lot' s of thought and legal advice needed. Organized crime is not tolerant with even the slightest interference.

 

Thank you for joining the conversation.  It is important for us to raise awareness and discuss these issues out in the open.

@CPA_Melissa

Thank you for a most interesting Saturday morning read! I was not aware of this scam as I'm sure many colleagues in our profession are probably in the dark as I am.

I am not sure of the regulatory processes that the writer has in mind but for physiotherapy associations to create and regulate such a process costs $$$. As a therapist in a rural practice who does not have disposable income to spend on further costs related to insurance fraud I would suggest that the Insurance companies who are better served to manage insurance fraud remain with the task of regulating the process.

Thanks again for these reps...most thought-provoking.

Cal

 

 

 

Fraud is a criminal offense and must be investigated and dealt with by the justice system. However, we all need to be alert and report incidents to the proper authorities when we become aware of suspected fraud. 

One of the goals of #30reps is to increase awareness and another is to provide tools to deal with difficult issues (stay tuned...)

@CPA_Chantal

Not usually an internet commenter, but feeling compelled on this one as I'm finding myself experiencing a rather strong emotional reaction to this story.  40 cases in Toronto alone?  I wonder over how long a period?  I think the reason that I'm feeling so strongly about this is that I, as I'm sure have others, have stuck my neck out on more than one occassion to defend the value of PT practice for management of impairment and disability after car crashes (let's try to stop calling them 'accidents').  I and others have put our reputations on the line several times in the interest of defending our profession, so while I get that those involved in organized crime won't care a lick about this plea, I hope that if there are any PTs out there who are getting involved either intentionally or unintentionally to think about the impact on those of us who are trying to defend and protect our position in this field of care.  And to those who hear about it happening, even if you're not directly involved, please either speak up or know that you're guilty by virtue of silence.  Don't underestimate the power of a unified voice - we're all in this together.

As a self-regulating profession, it is the professional responsibility of every member to call each other out for bad behaviour, and to report to the regulatory colleges as necessary.  Being passively silent shouldn't be an option.

@CPA_Melissa

this is a minority and we don't need more regulation.  The amount we spend on licensing is rediculus and disproportionate to PT licensing bodies in the states ie CT NY MI less than 150/ year and to other professions in Ontario nursing was less than 1/5 Th a few years back. 

 

I had no idea this was happening! Shocking!

Self-policing and regulation probably needed.

 

 

It is scary to think that criminal elements can use our registration/licence numbers. 

Perhaps the physiotherapist needs to approve the billing by using a password. Billing ca still be prepared by the clinic but it then needs to be 'approved' by the physiotherapist?

Interesting proposal. Keep the ideas coming!

CPA_Chantal

I was an invited speaker to a conference sponsored by the insurance industry in the UK a few years ago. While the evidence-foundation to best practice was being presented, other challenges were also being discussed. This (organized crime in rehab) was huge. As poverty loomed, there was a higher unemployment rate and basic cost of living was a growing challenge to the UK society, the incidence of fraudulent accidents had sky rocketed. The insurance industry pays and our insurance rates sky rocket as consumers. PT face the same challenge as those with faudulent injury enter the clinic as well and seek care to gain the benefit of buy outs and insurance support. Does our "PT-education" prepare us for such a patient population? :[ :(

I also must say I do note/suspect it in my practice but am not always clear on how to ID cases...

Anita Gross

 

Interesting comments.  

I would be intersted in knowing if there are any resources out there to help clinicians.  Please share if you have any ideas.

Another victim of fraud not mentioned in the post is our MVC clients who face an uphill battle in trying to access the services they require. I have heard horror stories from clients being put through independent evaluations, made to feel like criminals because of the people out there committing fraud. As a community based PT, I see my clients at their best and worst. I know the intimate details of their family life and the holistic challenges they face as a result of their injuries. The IE assessor sees one snapshot of the patient's life and has the power to deny a client of vital services. Like the commenter above, I too have stuck my neck out to defend my clients to adjustors. This criminal activity is a shame for all affected.

@dkjacks

 

 

Thank you for sharing this perspective.  It is easy to forget how legitimate MVC patients are negatively impacted by fraudulent behaviours of others.

@CPA_Melissa

I have on occasion called the claims adjudicator when I feel a patient is embellishing his/her symptoms. I was told to wait until we had spent the $2K for physiotherapy and then they would look into it! Ridiculous! I try as much as possible not to treat motor vehicle accidents due to the above.

Leave a Reply

Your email address will not be published. Required fields are marked *