• 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:

  1. An ineligible person receives or attempts to receive an insured service as if he or she were an insured person.
  2. 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.
  3. 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.


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