Medical Services Fraud

​​​​If you are injured in a vehicle collision, medical services help you recover. However, unscrupulous rehabilitation clinics and assessment centres may engage in fraudulent activities.  ​

There are a number of ways fraudulent activities may take place when it comes to medical services fraud.  Some examples may include: 
  • Overbill for services performed or bill for services that are not performed
  • Provide and bill for additional, unnecessary assessments, treatments, examinations or assistive devices
  • Provide and bill for an uncovered service as though it is a covered service
  • Bill for assistive devices that are never provided 
  • Abuse or falsely use credentials of health practitioners to authorize billing frauds.​

Who is Involved with Falsified Documentation?

During or after a patient receives legitimate medical care, falsified documents may be submitted by dishonest medical service providers. A patient who signs a blank form or whose signature is physically or electronically forged may not be aware of the fraud. Similarly, a health care practitioner who does not know his or her credentials are being fraudulently used may be unaware of false or exaggerated billings. 

In some cases, a complicit patient and/or health care practitioner takes part in false or exaggerated billings. A patient who never sustained injuries in a legitimate (staged or caused collision may make a false injury claim. 

How Patients Can Avoid Medical Services Fraud 

After an injury, protect yourself and ask to see the credentials of the practitioner who provides your medical services. You may consider checking the public registry of the practitioner’s affiliated college to confirm his or her professional status. Never sign blank medical insurance forms and never sign any documentation without being fully aware of the content.

Professional Identity Theft Scenarios

The false use of a health care practitioner’s name and professional credentials is a serious problem and can happen in several ways:

  • A practitioner may work at a facility and submit valid treatment and assessment plans to insurance companies. An unscrupulous facility may submit additional requests for unnecessary treatment and assessments under a practitioner’s name without the knowledge or consent of the practitioner.
  • A practitioner may have once worked at a facility that continues to submit requests for treatments or assessments and/or invoices under that practitioner’s name after the practitioner leaves.
  • A practitioner may have never worked at a facility. The practitioner’s professional credentials are obtained without her or his knowledge and are fraudulently used by the facility to authorize insurance forms. 

How Practitioners Can Avoid Identity Theft 

Know what requests for treatment or assessments and invoices are submitted to insurers under your name. Maintain independent access to all patient records and/or keep an independent file for all patient documentation. 

Additional Resources

Ontario only: