Report: City of Toronto employees have claimed thousands of dollars in 'suspicious' medical expenses

Mar 28 2017, 4:23 pm

Either working for the City of Toronto is hella’ stressful or government employees treat their medical benefits like the credit card of a mall teen’s dad.

Maybe both, certainly the latter.

According to Toronto Auditor General Beverly Romeo-Beehler, city employees are guilty of “suspicious” spending on massages, physiotherapy, and orthotics.

“In 2015, the City spent approximately $229 million to provide employee benefits including health, dental, long-term disability and employee life insurance, of which approximately $56 million was for extended health care benefits (excluding drug benefits),” said Romeo-Beehler in a summary released to city council.

She revealed the findings late last week at an audit committee meeting and has recommended Manulife, the city’s insurer, to disclose medical information about medical providers that could prevent fraudulent claims.

Among the “suspicious” cases were a family of six receiving massage therapy six times in 10 weeks, one employee with three dependents receiving $28,500 after claiming 60 pairs of orthotics, several families claiming an “unusually large number” of medical braces (with one being reimbursed $38,000 over three years), and 17 individuals claiming more than $10,000 worth of physiotherapy in one year.

This isn’t the first time that city employees’ health benefits spending has come under scrutiny. In October of last year, Toronto’s Auditor General was critical of reimbursements for oxycodone, fentanyl, and erectile dysfunction drugs. These weren’t just regular doses, either – 16 claimants received an equivalent of two to five years’ supply of oxycodone in one year and 32 claimants received up to almost seven years’ supply of fentanyl patches in one year.

Of most concern to Romeo-Beehler is “unlimited” coverage extended to dependents of city employees.

“Sickness is random — there’s going to be people within a family that get physio,” Romeo-Beehler said. “But not the entire family.”

Her report admits controls and monitoring of the city’s benefit claims have been ineffective in identifying unusual patterns or potential frauds. Whether the city chooses to follow up on her recommendations to curb spending remains to be seen.

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