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Hospitals and health care facilities across the province have experienced numerous cases of practitioners misusing workplace benefits plans. As a result, many healthcare practitioners are being terminated from their employment, or are otherwise having the misconduct reported to their regulatory colleges, most prominently being the College of Nurses of Ontario.

Workplace Benefits Fraud

Workplace benefits fraud takes place across any professional landscape. Any individual who is alleged to have misused employment benefits can face serious consequences, including termination of employment, civil action(s), and criminal complaint(s) which can lead to charges, a conviction and a criminal record.

Benefits fraud takes on many forms and, generally speaking, involves a misrepresentation being made by an individual to an insurance company regarding a claim for insurance benefits. If an insurance company contacts you and requests additional information regarding your claims or notifies you that an audit or investigation has been commenced, you should contact a lawyer.

Consequences for Regulated Health Professionals

Employers of regulated health professionals have an obligation to report any instances of professional misconduct to the professionals’ regulatory college. This includes the misuse of employment insurance benefits.

Any time an insurance company notifies an employer, including a hospital or other healthcare facility, that a regulated health professional is alleged to have misused benefits, the employer has an obligation to notify the respective regulatory college.

Regulated health professionals who are alleged to have misused insurance benefits are therefore not only at risk of termination, civil action(s) and criminal action, but are also at risk of regulatory action being taken against them by their regulatory college.

The regulatory colleges can take any number of steps when notified of such an allegation, including commencing an investigation, referring the matter from the Inquiries, Complaints and Reports Committee (“ICRC”) to the Discipline Committee, and taking disciplinary action such as issuing a caution, reprimand, or suspension, or ordering that the health professional attend for a specified remedial or educational program.

It is important for regulated health professionals to seek legal representation early on in this process. Contact our office to schedule a free 30-minute consultation with one of our lawyers.

By: Kelsey L. Ivory -

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