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August 4, 2007

Doctors Milking Workers' Compensation

Single medical practice says it reviewed 13,354 WCB cases in a year


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 critics.

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 problems.

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, double billed.

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 problem.

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' lives.

"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.

Also see the Edmonton Sun's series, a scathing expose of the Alberta WCB by Jeremy Loome

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