Another problem has surfaced connected with the federal government’s health programs for aboriginal communities.
Aboriginal leaders have been warning for weeks that a crisis is developing over a decision to delist the powerful and much-abused painkiller Oxycontin and its successor OxyNeo because a high percentage of northern Ontario aboriginals are addicted to it.
Now The Canadian Press reports Health Canada called in the RCMP to investigate an alleged potential fraud involving a so-called “gift-basket” scheme connected to a Winnipeg drug store.
Health Canada estimates it overpaid Pharm Azeem by up to $160,389 through the Non-Insured Health Benefits program, which covers health-related goods for aboriginal Canadians not insured through the provinces, territories or private insurance.
The Canadian Press said an access-to-information request turned up an audit the described how the drug store allegedly gave away items such as dandruff shampoo and condoms along with prescriptions, then billed the government for all of it.
“Improper billing for over-the-counter products was found,” says the 2006 audit by Health Canada. “A pattern of bundling five over-the-counter products for gift baskets leads the auditors to believe that this action was to inflate billing costs to the Non-Insured Health Benefits program for financial gain.”
The benefits plan covers some over-the-counter medications with a doctor’s authorization. Health Canada claimed the pharmacy routinely added verbal prescriptions phoned in by doctors, which were accepted by the program.
“The practice was so institutionalized that a review of the pharmacy’s records found that the provider was using a pre-typed sticker with exactly the same five items for almost all clients. … ” the audit report said.
“It appears that the pharmacist planned what would be prescribed prior to receiving the verbal orders. This practice became apparent after the pharmacy began ‘giving’ (and billing) the same five items consistently to (Non-Insured Health Benefits program) clients.”
Health Canada has since negotiated a $25,000 settlement with Pharm Azeem. But owner Rehan Azeem denies he did anything wrong and told The Canadian Press the allegations cost him his business and his health.
“We lost everything,” he said, adding all the items were properly authorized. “There was no such thing as gift baskets.”
Azeem claimed providing such things as dandruff shampoo and anti-fungal cream was a service to aboriginal communities because of poor hygiene conditions.
The audit found Pharm Azeem billed the program a $5 dispensing fee for drug prescriptions but also added the cost of the bundled items and an additional $25 dispensing fee per order. All above board, Azeem said.
“You have to look at my overhead costs, and the pharmacist costs,” Azeem said. “I was not making a big chunk of money.”
Once it began bundling items, Pharm Azeem’s payments from the benefits program went from $32,032 in 2001 to $301,434 in 2005.
The report found the drug store was bundling condoms with prescriptions for children as young as two years old. Azeem blamed a computer-entry error.
Health Canada suspended Pharm Azeem’s billing privileges in February 2006 and brought in the RCMP the same year. The Mounties would not discuss the investigation.