City of Toronto audit raises flags on massages, orthotics and more
Beverly Romeo-Beehler called for tougher fraud detection measures after her audit revealed questionable claims.

TheStar.com
March 21, 2017
David Rider

Toronto taxpayers footed the bill for hundreds of thousands of dollars, and possibly more, in questionable employee benefit claims for orthotics, compression stockings, therapeutic massages and more.

A report by Auditor General Beverly Romeo-Beehler released Tuesday calls on the city to toughen fraud detection measures in her latest look at city employee health benefits that cost the city a total of $229 million in 2015.

“Overall, we found the controls and monitoring of the city's benefit claims ineffective in identifying unusual patterns or potential frauds,” wrote Romeo-Beehler wrote.

The audit confirmed with Manulife, which managed city benefits until it was replaced with another company last year, about $75,000 in overpayments due to adjudication errors which the city should try to recover, she added.

The audit identified a number of “high-risk” claims that, though they could be legitimate, should have been flagged for review, according to a document released by Romeo-Beehler’s office.

Her findings covering 2013 to 2015 include:

• Each of the six members of an employee’s family reported receiving massage therapy on the same day on six different occasions within 10 weeks, receiving about $3,000 in reimbursement. On each date the family claimed a total of 5.5 hours of massages — each signed off by the same massage therapist.
• Some 124 dependents aged 18 or younger were reimbursed for compression stockings.
• The audit identified “two medical supplies and equipment providers with suspicious activities. They have been referred to Manulife for investigation,” which could yield a “significant financial impact” for the city.
• Forty-one dependents aged 18 or under claimed in one year between six and 10 pairs of orthotics — supports, braces or splints, usually custom-made — each receiving between $3,000 and $5,000.
• One of those dependents was reimbursed about $3,800 for modifications on seven pairs of orthopedic shoes and $2,000 for 4 pairs of orthotics just in 2015.
• One employee’s family got more than $31,500 for more than 60 orthotics over three years.
• Seventeen people each claimed more than $10,000 for physiotherapy in one year.

The first phase of Romeo-Beehler’s audit, released last fall, specifically examined drug claims. She found city workers made millions of dollars in questionable claims for large quantities of erectile dysfunction pills and highly addictive opioids including Fentanyl.

Romeo-Beehler said at the time Toronto police might be called in. Mayor John Tory said any staff found to have abused the system should be fired.

Assistant Auditor General Jane Ying would only say Tuesday that the audit continues and there will be an update in June.

Since Manulife is no longer administrating Toronto’s health and dental benefits, and is not obliged to co-operate with her probes, Romeo-Beehler has abandoned plans for an audit focusing on dental benefit claims.