Police could probe Toronto city staff drug plan claims
The auditor general said it's possible the questionable claims are medically necessary, or addiction or fraudulent sales

TheStar.com
Oct. 28, 2016
David Rider

Any City of Toronto staff or family members who fraudulently got free quantities of Fentanyl or Viagra from the city drug plan could be hearing from the police.

The city’s auditor general, Beverly Romeo-Beehler, stressed to reporters at an audit committee meeting Friday that her probe into questionable drug claims is not yet at the stage where her staff and medical experts can say big purchases, including multi-year supplies bought in a single year, are fraud.

Romeo-Beehler, who presented her report on narcotic and sex-enhancement drug claims, expects to get access to plan members’ individual records through plan administrator Manulife in the next couple of weeks.

Individuals’ purchases of more than $5,000 worth of erectile dysfunction drugs and, in other cases, five years’ worth of highly addictive oxycodone in a single year might be medically necessary, the auditor said, “but we have to look at it.”

She told the audit committee it is possible some of the bulk purchasers are addicts. Others might be illegally reselling their medication for profit. Some 80,000 city employees and family members are covered by the drug plan fully funded by the city.

“When we have a case where there is a potential for fraud, the police would be involved. We would refer to police,” Romeo-Beehler told reporters.

She suggested city managers would be informed and it would be up to them to consider any disciplinary action. Mayor John Tory said this week any staff found to have abused the system should be fired.

The union representing about 20,000 “inside” workers said it has for years asked city management to ensure there are “screens or mechanisms” to reveal unusually high benefits costs. CUPE Local 79 president Tim Maguire told reporters he won’t stand in the way of any investigations.

“If there’s fraud they need to action on fraud and that could involve labour relations at the city, it could involve police,” Maguire said. “We would be involved in representing our members that are accused but the city has a right and a responsibility to take action to protect our plan.”

Erectile dysfunction drugs cost the city $1.9 million last year. City of Toronto plan members buy erectile dysfunction drugs at more than three times the rate of members of other plans administered by Manulife.

Narcotic pain relievers also cost the city about $1.9 million. Plan members billed the city for another $1.2 million in sedatives and stimulants. The audit found that 348 people were reimbursed for multiple purchases of the same drug on the same day, Romeo-Beehler said, adding it’s possible some of them are “double doctoring.”

Audit committee members commended the probe and urged Romeo-Beehler to continue.

Councillor Mary-Margaret McMahon marveled that five people claimed more than $5,000 worth of sex-enhancing drugs in one year while another 37 people claimed more than $3,000 worth.

“Presumably one person is not consuming that amount themselves unless they are going into the Guinness Book of World Records, so something else is happening with the drugs,” McMahon said.

Maguire said his union is willing to talk to the city about caps on specific medications. Romeo-Beehler suggested capping annual erectile dysfunction claims at $500 a year could save the city $750,000 a year.

The audit committee and city manager accepted Romeo-Beehler’s18 recommendations for tightening controls that could save the city more money. Manulife will be replaced at the end of the year with Green Shield Canada, which won a five-year contract to oversee the benefits plan.