"LEAKAGE" = ..DIFFERENCE BETWEEN WHAT AN INSURER SHOULD PAY IN CLAIMS UNDER THE CONTRACTUAL POLICY AND WHAT IT ACTUALLY ENDS UP PAYING.. LEAKAGE OF AN AVERAGE INSURER IS TYPICALLY 8-12 PER CENT.
"LEAKAGE" INCLUDES FRAUD
Comment by Dr.A.Franklin. In past 45y of OHIP cannot recall a media reported Ont.Govt prosecution against an Ontario resident for OHIP fraud. The only one I remember was settled out of Court. An Ontario resident lent his card (no photo at that time) to an Overseas relative of same gender and approx same age who had heart operation and died. When Ontarian next visited his MD was informed that he`was dead. Case settled out of Court for less than $60,000 billed by OHIP..
Other causes of OHIP (Ont Health Ins.Plan) "leakage:".
No verification of signature. on card by Clinics & Hospitals.
Many No-photo cards still legally in use.
No photo required on over 65y. cards; so elderly do not have to travel to OHIP offices with cameras
"Lost" OHIP:paid drugs for Welfare & Seniors.
"Spilled" medication on floor etc..
Unlike UK where patient is registered with one GP or one Clinic,. in Ontario patients can WALK-IN to a variety of GPs and ask for medication; (=multiple doctoring).
Demand for antibiotics with threat of CPSO complaint if MD non-compliant.
Supplementary food money grant (NOT food stamps) for those on welfare with conditions such as constipation now stopped due to widespread fraud. MDs threatened with complaint to CPSO if they did not comply with often absurd demands.
Methadone clinics.
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