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Health minister says ‘action’ is needed but vague on how to stop crooked pharmacists

Global News with Kelly Grindrod 28 February 2019

Ontario Minister of Health and Long-Term Care Christine Elliott said Thursday that she is “aware” of the pharmacy fraud brought to light in a Global News/Toronto Star investigation, adding: “It is something that I take very seriously.”

The investigation exposed pharmacists who are overbilling the Ontario Drug Benefit Program (ODB) and, at times, pocketing hundreds of thousands, — if not millions — of dollars.

“We want to know what’s happening and then what steps need to be taken by the College (of Pharmacists) or by the ministry so it’s probably going to be on both sides that action will need to be taken,” said Elliott.

When asked what steps might be taken, Elliott was vague on details.

The Office of the Auditor General of Ontario has previously called out the ministry on four occasions for having too few inspectors.

“There are 4,200 pharmacies; they only inspect about six per cent a year,” said current auditor general Bonnie Lysyk in an interview. “There’s more money to be recovered.”

“That might be one of the solutions,” said Elliott. “We’re still discussing the situation with the ministry.”

Lysyk said the AG report identified $3.9 million in 2015-16 in inappropriate payments made to pharmacists through the ODB, including $900,000 in billings related to prescriptions being filled for deceased people.

“Governments don’t like to increase staff because they’re trying to save money. But at the same point, perhaps that will end up recouping more money into the public purse,” Lysyk said.

The ODB pays for medications for Ontario’s neediest: children, the elderly and those on social assistance. When a qualified patient fills a prescription, they either don’t pay anything or pay a few dollars, and ODB covers the rest.

The program costs the province more than $5.4 billion a year.

Dishonest pharmacists overbill by tacking extra drugs that they never dispensed onto these bills so they are reimbursed for more drugs than they have sold. Untold millions intended for the sick and needy end up in their pockets. And, the investigation revealed, very few pharmacists are getting caught.

Of the more than 16,000 pharmacists in Ontario, only 39 were disciplined by the College of Pharmacists for unsubstantiated ODB billing between 2013 and 2017, according to an analysis of college records. This number includes pharmacists disciplined for poor record-keeping.

“In other provinces, for example, every time a medication is dispensed through a pharmacy, a record is created,” said Kelly Grindrod, a pharmacy professor at the University of Waterloo.

“And if a physician was to look at the list of medications that had been dispensed for their patient, they could see some of these things,” said Grindrod.

With more scrutiny on which medications are being dispensed to patients, the province wouldn’t need to rely on a tiny number of inspections to catch pharmacy fraud.

“We need to use technology more,” said Elliott. “There are many digital tools that are out there that can help us to deal with that, and we need to take advantage of them.”

Ontario NDP Leader Andrea Horwath said the depth of pharmaceutical fraud uncovered in the Global News/Toronto Star investigation is shocking, calling it “completely unacceptable.”

“We all know not every pharmacist is frauding the system and not every pharmacist is going to be writing inappropriate prescriptions, but there’s enough of a problem here and it’s systemic enough that there needs to be some focus on it,” said Horwath.

Three different bodies — the Ministry of Health, the OPP and the Ontario College of Pharmacists — are tasked with catching pharmacy fraud.

In a written response to Global News, the college said it has added “additional resources” in pharmacy and practice assessments.

However, the college added, those assessments “do not function as a billing auditing tool.”

“All of our investigators do and will continue to investigate matters involving improper billing practices that come to our attention,” said the college.

In the five-year period analyzed in the investigation, only seven pharmacists were charged with criminal offences and four others with lesser provincial offences.

Pharmacists charged with ODB fraud aren’t getting convicted. The investigation found only two pharmacists convicted of criminal offences for overbilling during this time period and three more convicted of provincial offences.

When asked about possible solutions, Horwath said that getting serious about investigations and keeping a more diligent eye on pharmacists could deter this from happening in the future.

“The government has an obligation to clean up this situation and to give confidence back to people that their Ontario Drug Benefit Program is being operated with some integrity,” said Horwath.

“I’m concerned that this is going to go off the front burner and it’s going to be swept under the carpet and it’s going to be status quo into the future, and that’s not acceptable.”