The Ministry of Health and Long-Term Care is committed to detecting abuse and misuse of the Ontario health care system
What is OHIP fraud?
It includes :
- Someone knowingly using a health card that is not theirs
- Someone receiving OHIP services who is aware that as a non-resident of Ontario they are not eligible.
- Someone who knowingly gives false information to the ministry to become or continue to be an insured person when they are aware that they are not eligible.
Who is eligible for Ontario health insurance coverage?
Generally speaking, Canadian citizens, permanent residents or landed immigrants, convention refugees (protected persons), or a person registered as an Indian under the Indian Act, or others listed in Regulation 552 under the Health Insurance Act are eligible for Ontario health insurance coverage provided they :
- Make their primary place of residence in Ontario, and
- Are physically present in Ontario for at least 153 days in any 12-month period.
The ministry investigates each and every allegation it receives regarding potential health insurance abuse.
Ontario health insurance coverage is cancelled where health card holders are unable to prove entitlement to Ontario health insurance coverage. Where fraud is suspected, cases are referred to the Ontario Provincial Police Anti-Rackets Health Fraud Investigation Unit for investigation and possible prosecution.
Under the Criminal Code of Canada Section 380, a person convicted of fraud exceeding $5,000 could be imprisoned up to 10 years. Restitution may also be ordered under the Criminal Code.