REP 4 - Organized crime in rehab? Surely this can’t happen in Canada!
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.
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.
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?
- Did you even know that there are scams like this that happen in Canada?
- What should be done to prevent organized crime in physiotherapy?
- Do we need more regulation or better self-policing?
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