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One of the largest benefit fraud schemes was uncovered Wednesday at Baycrest Hospital in Toronto.
Recently conducted audits show that roughly $5 million in benefits has been falsely claimed over the course of eight years by 150 employees across multiple professions. All employees implicated have since been fired.
The audit found that some employees had taken more than $100,000, while many others had managed to obtain $25,000.
“This audit found irregularities,” a spokesperson for Baycrest told Global News. “We then conducted a workplace investigation, which found that a significant number of employees were misusing our benefits plan over the course of a number of years.”
“The majority of those staff found to be involved were unionized,” reports the National Post. “They span many job categories, and include registered nurses, whose profession is regulated and licensed, such that misconduct must be reported to their college.”
William Reichman, president and CEO of Baycrest Health Sciences believes that the operation was organized between the staff involved. “It had to be done in such a way that it would escape at least detection by the benefits administrator… It’s a betrayal of trust,” said Reichman.
Baycrest has spoken to police twice so far, but no criminal charges have been laid. Police have had no formal involvement in the case.
Det. Sgt. John Whitworth has said that the hospital took up the investigation by themselves as part of an internal probe, and that it has yet to involve public safety and thus justify police intervention. The “ball was left in their court” he told the National Post.
According to the National Post, two main types of fraud have been uncovered: employee requests for services they never received, wherein they would “pay a kick back to the provider”; and employees accepting unrelated products, such as purses and other clothing or accessories, “with the provider pocketing the difference in price between those items and the prescribed medical device”.
The exploited benefit plan also has implications for the people of Ontario, with 75 percent of funding coming from the provincial government and only 25 percent coming from employee programs.
Auditors discovered the fraud months ago when investigating a partnership between hospitals and providers. According to the National Post, “By looking at Baycrest’s providers, the consultant recognized some from other cases of benefits misuse involving orthotics, orthopedic shoes, compression stockings and braces.”
Baycrest has since said that more audits will be conducted and that an approved provider network will be set up to teach staff about the benefits plan and ensure such oversight never happens again.
Several confessions have been taken from the staff involved and Whitworth has said that he expects to be contacted in the coming week to launch a formal police investigation, but otherwise no action will be taken.