Mayor calls for terminations after medication fraud report
Damning audit finds millions in tax funds spent on dubious drug claims.

thestar.com
By Jennifer Pagliaro and Donovan Vincent
Oct. 26, 2016

City workers who submit questionable or fraudulent claims for drugs such as erectile dysfunction medications and opioids should face termination, says Mayor John Tory in the wake of a damning audit that found millions of tax dollars are being spent on dubious claims.

“And I would suggest that termination (is) an appropriate kind of penalty for that sort of thing because we cannot, in a circumstance where we’re trustees of the public’s money, allow it to (be) abused whether it’s for Viagra or any other drug or any other purpose whatsoever,” Tory told reporters at City Hall on Wednesday.

The mayor’s comments come after a scathing report released Tuesday by auditor Beverly Romeo-Beehler looking into “potentially excessive and unusual drug claims” found widespread problems with claims related to erectile dysfunction (ED) drugs Viagra and Cialis, as well as opioids including the highly addictive painkillers oxycodone and fentanyl.

One expert, Dr. Meldon Kahan, medical director of the substance-use clinic at Women’s College Hospital in Toronto, says he’s very disturbed by the findings in the auditor’s report pertaining to opioids, saying the conclusions point strongly to drug abuse and drug dealing.

For example, the auditor’s report found 16 claimants had an equivalent of two to five years’ supply of oxycodone in at least one year, and 32 claimants had an equivalent of 19 months to 6.7 years’ worth of fentanyl patches.

The report also found examples of “double doctoring,” prescription forgery, and duplicate billing. In one case, 27 claimants were dispensed the same prescription opioid, including methadone at different pharmacies on the same days.

“Given the fact so many in Ontario are dying of opiate overdoses and so many are getting addicted and prescription opioids are a major cause of overdose deaths and rates of addiction ... this is a really concerning kind of report,” Kahan said.

For ED drugs, the report found 37 claimants were each reimbursed over $3,000 and five people were reimbursed over $5,000 last year, and that the city has no maximum coverage limit or “cap” for these kinds of drugs.

The report recommended a cap of $500 for these drugs and says the city could save $750,000 a year by doing so.

The report found the city could save an additional $185,000 by reducing dispensing fees for drugs.

Last year the city spent $1.9 million covering claims for ED drugs such as Cialis and Viagra.

The city’s drug benefits plan is administered by Manulife, though a new company Green Shield Canada, will take over that role at the start of next year.

In an emailed statement Wednesday, Anne-Julie Gratton, a Manulife spokesperson said the parameters of benefits/drugs plans are “set by employers” (plan sponsors) and that Manulife’s role is to “administer those plans.”

“I recommend that you contact the City of Toronto directly about these questions,” she said in response to the Star’s queries including whether Manulife was aware of the extent of the problem surrounding the billings, whether this is a common problem for the company in other municipalities, and whether Manulife is planning to address the problem.

City spokesperson Deborah Blackstone said that during the auditor’s probe, the city wasn’t able to obtain certain information from Manulife to address “questions and clarification inquiries regarding claims related data.

“As a result, without this additional background information, the city cannot establish to what extent the concerns raised in the Auditor General’s report may be addressed or explained,” she added.

But the city will meet with Manulife to address the auditor’s findings, she said, and the city will move to recover ineligible payments or overpayments when they are identified.

The city will review its benefit plan and make changes to be more cost effective, subject to collective agreements with city unions.

Regarding the erectile dysfunction drugs, Tory quipped that “if there is evidence of somebody using 500 pills in a year, you know, I’m happy to honour all kinds of athletes down here and I would perhaps even invite the person in for a visit.

“But I would say that that goes beyond what the citizens of Toronto would say (that) the taxpayers should support,” the Mayor added.

On Tuesday, Councillor Stephen Holyday, vice-chair of the audit committee, said the auditor’s report instilled a “real sense of urgency” in fixing the claims problems, and added “this is all taxpayer money and at the end of the day it’s important we keep an eye on it.”

Kahan, the expert at Women’s College, said opioid misuse is a terrible public health problem, and the auditor’s report suggests Manulife and the city need to beef up their oversight of claims.

But it’s also the responsibility of physicians to prescribe more carefully, he said. “Whether or not the patient is covered by a provincial drug plan or a city drug plan, or paying out of pocket, the root of the issue is that physicians need to prescribe more carefully.”

“If the (city and Manulife) are getting claims that are suspicious or (they’re) concerned about the amount of opiates or erectile dysfunction drugs, they need to get back to the doctor and say ‘what’s going on?’ ” Kahan said.

He referred to the fact that the Workplace Safety and Insurance Board has a narcotics strategy for injured workers that’s aimed at curbing abuse of and addiction to painkillers.

For example, the program only allows prescriptions for short-acting narcotics - a category that including oxycodone - for a maximum of 12 weeks.

The city of Toronto’s drugs and benefits plan is provided for under collective agreements with its unionized workers. Tim Maguire, president of Local 79, which represents the city’s inside workers, says he couldn’t comment on any specific drugs, but said his union has called for better screening to control costs and prevent fraud, but those calls have “fallen on deaf ears” at the city.

In terms of the ED drugs, Kahan says he thinks it’s “a bit of a stretch” to call the drugs medicine that’s important for health.

“The way we decide if something is important for health if it increases life span, or increases function or relieves symptoms of something, pain or emotional distress and so on. I think it’s a stretch to call these drugs essential medicines, I don’t think they are,” he added.

But there are other cities that have drug plans that include Viagra and Cialis. The drugs are known to be prescribed to counteract the symptoms of impotence caused by antidepressants, for example.