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August 4, 2007
Doctors Milking Workers' Compensation
Single medical practice says it reviewed 13,354 WCB cases
in a year By JEREMY LOOME,
It's a medical miracle - so much so that the Alberta
government needs to explain how one local medical practice was allegedly able
to review 13,354 Workers' Compensation Board cases in a single year, say
The statistic was identified last year by Alberta's auditor
general as being one that cried out for a fraud investigation.
It was revealed in last year's report, at the same time as
an audit that found nearly 10,000 cases of double billing to both the WCB and
Alberta Health by doctors, worth $718,000.
But so far, the government has remained silent about both
When asked by Sun Media about double billing earlier this
year, Health Minister Dave Hancock seemed unaware of the problem, but promised
to look into it. The government made no mention of the individual case, which
stemmed from a review of billing in 2003-2004.
In fact, sources indicated to Sun Media the department has
yet to even buy the necessary equipment; the AG's findings were based on
forensic auditing analysis from a supercomputer; the provincial employee
charged with reviewing the case doesn't have access to the same machine and
hasn't been provided with another.
The government could not immediately comment on the doctor
who referred 13,354 cases because the investigator on the case was not
available yesterday, Alberta Health spokesman Howard May said yesterday.
But May did say the government has already checked the
9,800-plus cases of double billing and found that only one-third were, in fact,
He could not explain how the government reached that
conclusion or the process it followed. He also would not guarantee that that
statistic would be reflected in the next auditor general's update of the
The situation does not leave Albertans with cause for
optimism, noted the NDP's Ray Martin.
"This is beyond belief. The public has a right to know if
someone is fraudulently taking money out of the WCB," he said. "That's directly
coming out of injured workers and employers and that's a very serious matter.
"13,000 in one year? It's impossible. They can say it's a
computer glitch ... but at some point they need to provide some evidence that
they've dealt with this problem and properly investigated."
In fact, for an individual practice - let alone an
individual doctor - to rule on that many cases, they'd have to review 36.5
medical case files daily for a year, with no days off.
Not only does that mean the doctor or doctors involved were
likely committing financial fraud, said Martin, it also means they were ruling
on cases without considering the facts, potentially ruining injured workers'
"It really surprises me, the snail-like pace at which the
government proceeds to investigate and correct so many difficulties in the
Department of Health and Wellness," said Liberal health critic Laurie Blakeman,
suggesting that by ignoring health-care card fraud for years, the government
cost taxpayers almost three-quarters of a billion dollars.
Double billing may amount to less waste, but that's hardly
the point, she said.
"People are often suspicious of the system and of double
billing and they're usually greeted with a fair amount of derision for
complaining," said Blakeman.
"But this seems to indicate Albertans have a much better
idea of what's really going on than the government does," she said.
see the Edmonton Sun's series, a
expose of the Alberta WCB by Jeremy Loome
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