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