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CMAJ • July 22, 2003; 169 (2)
© 2003 Canadian Medical Association or its licensors

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Research letter

An analysis of one potential form of health care fraud in Canada

Henry Thomas Stelfox and Donald A. Redelmeier

From the Departments of Medicine (both authors) and Health Administration (Redelmeier), University of Toronto, Toronto, Ont.; the Graduate School of Arts and Sciences, Harvard University, Cambridge, Mass. (Stelfox); and the Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ont. (Redelmeier)

Correspondence to: Dr. Donald A. Redelmeier, Sunnybrook and Women's College Health Sciences Centre, Rm. G-151, 2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-6048; dar{at}ices.on.ca

HEALTH INSURANCE FRAUD is a potential source of expense, injustice and adverse events in medical care. We examined one type of such fraud: false claims for prescription benefits after the death of the beneficiary. Of 335 536 elderly people in Ontario who died between Jan. 1, 1991, and Jan. 1, 1997, we identified 113 for whom 1 or more prescription drug benefit claims (about 1 per 3000 deaths) were submitted more than 1 year after their death. Claims for expensive medications were rare, as were those for addictive medications. Our findings suggest that this type of health care fraud occurs infrequently and that countermeasures are unlikely to substantially reduce medication abuse in Canada.




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