6 Jun 2015

"GREY AREAS" STEINECKE MACIURA LEBLANC LAWYERS

"GREY AREAS": a review of selected Court cases: free on-line.
(SML ONLY PROSECUTES MDs DOES NOT DEFEND MDs ).

rsteinecke@sml-law.com
416 625-6897
401 Bay street,suite 2308 (near Queen St.West)

CMAJ & OMA (4 in-house lawyers) provide no legal commentaries on Cases relevant to physicians.



RSteinecke_Web
Richard Steinecke practises law exclusively in the area of professional regulation. He is the editor and writer of the widely read Grey Areas newsletter commenting on recent developments in professional regulation. Because of its comprehensive nature, courts and tribunals have cited his book “A Complete Guide to the Regulated Health Professions Act” well over dozen times even in cases dealing with non-health professions. The book is updated twice a year.
Today he spends most of his professional life teaching, writing, speaking, training and consulting on professional regulation issues. A life-long learner, Richard reads every Canadian common law court decision on professional regulation he can find and has a Certificate in Risk Management from the University of Toronto.
  • Richard Steinecke has been published in the May 2015 edition of HEALTH LAW IN CANADA.. His article entitled “Applying Risk Management Principles to the Complaints System of Regulators” can be found at pages 98.- 105 .

Applying Risk Management Principles
to the Complaints System of Regulators

 Richard STEINECKE

Introduction:

Risk management has become a popular tool to
assist organizations identify and address challenges.
There are some barriers to applying risk
management processes to regulators. Risk management
is most prominent in the business world,
where the primary goal of the organization is to enhance
profits. In the business world, even considerations
such as reputational damage and fairness to
employees can be measured in terms of its impact
on the organization’s net revenue. The goals of
regulators are more difficult to define and measure.
In addition, regulators work in a very legalistic environment.
They have a specified legal mandate,
express and implicit statutory authority, and a
common law duty to act with procedural fairness.
Many of a regulator’s legal obligations are contained
outside of their home statute (e.g., human
rights codes, the Canadian Charter of Rights and
Freedoms, case law). As a result, the risk focus of
regulators often shifts to legal risks. An overreliance
on obtaining and following legal advice
can obscure, and even make regulators vulnerable
to, other very important sources of risk.
.

"CLAIMS CANADA" Can Independent Adjusters Assn..April/May 2015 "LEAKAGE" pp12-19 CRAIG HARRIS.

"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.



...