Overview

Health care fraud is a crime. It involves intentional deception to knowingly receive unlawful payments, health services or benefits. The province is committed to reducing fraud by working to detect, prevent and respond to suspected acts of fraud within our health care system.

Our health care system offers many different services, including:

In the event of suspected fraud, legal action is pursued by the Ontario Provincial Police and may lead to criminal or provincial prosecution.

Fraud within Ontario’s health care system

Fraud within Ontario’s health care system includes:

  • when a health care provider bills for services they are not entitled to claim
  • when a person attempts to receive a publicly funded health care service or benefit they are not entitled to
  • the inappropriate use of a health card or health card number (such as identity theft)

Examples of health care provider fraud

OHIP

Examples include:

Ontario Drug Benefit

Examples include:

  • billing for medications which were not provided to a patient
  • billing for medications which were different than what was provided to a patient

Assistive Devices Program

Examples include:

  • signing an application for a client who does not meet the eligibility criteria for a device
  • prescribing a device for a person who does not require it
  • invoicing for a device which was not supplied to a client
  • invoicing for a device other than the prescribed device, or invoicing for a higher cost device other than the prescribed device
  • providing used equipment to a client
  • failing to return funding when a client returns a device

Examples of individual health care fraud

OHIP

Examples include:

  • using or attempting to use a health card or health card number which is not their own
  • altering or attempting to alter the information on a health card
  • receiving OHIP insured services for themselves or their dependents who are aware that they/their dependents are not meeting OHIP residency requirements (for more information, visit Regulation 552)
  • receiving OHIP insured services for themselves or their dependents who are aware they/their dependents do not hold an OHIP-eligible immigration status (for more information, visit Regulation 552)
  • providing false information to the Ministry of Health (or its representative ServiceOntario), knowing they/their dependents are not eligible for OHIP coverage

Ontario Drug Benefit

Examples include:

  • transferring or attempting to transfer Ontario Drug Benefit program-covered medications to others (for example, sharing or selling medications)
  • falsifying or attempting to falsify drug prescriptions to obtain Ontario Drug Benefit program-covered drugs
  • obtaining or attempting to obtain Ontario Drug Benefit program-covered drugs from multiple health care providers

Assistive Devices Program (ADP)

Examples include:

  • continuing to accept funding from ADP for devices or supplies that are no longer medically required
  • continuing to accept funding on behalf of a deceased client

Report allegations of fraud

You can report allegations of fraud against Ontario’s health care system by:

The information you provide will be assessed and may be shared with law enforcement if fraud is suspected. If you suspect fraud, you can also contact your local police.