Toronto

Toronto auditor general finds city workers spending tens of thousands on orthotics, physio

Toronto’s auditor general wants more city oversight after finding some employees were spending thousands of dollars on massages, physiotherapy and in one case, dozens of pairs of orthotics.

Councillors back request for insurer to provide more information about employee benefit claims

Toronto's auditor general wants more city oversight after finding some employees were spending thousands of dollars on massages, physiotherapy and in one case, dozens of pairs of orthotics. (Credit unknown)

Toronto's auditor general wants more city oversight after finding some employees were spending thousands of dollars on massages, physiotherapy and in one case, dozens of pairs of orthotics.

Auditor General Beverly Romeo-Beehler says many of those cases, dating back to between 2013-2015, appear suspicious, and is recommending that the city's insurer, Manulife, provide more information about medical providers in the future to prevent fraudulent claims.

Romeo-Beehler unveiled her findings last Friday at an audit committee meeting where the serious allegation that the city was losing millions due to potential bid-rigging by paving companies took centre stage. The findings are the second phase of an investigation into how employees are using the benefits plan, which the city spent some $229 million per year as of 2015. 

Here's some of what she found:

  • One family of six received massage therapy on the same day, six times in ten weeks, costing the city about $3,000. The auditor noted the same massage therapist signed off on all 5.5 hours of treatment.
  • One employee with three dependents received $28,500 after claiming 60 pairs of orthotics.
  • Several families claimed an "unusually large number" of medical braces, with one being reimbursed $38,000 over three years.
  • And 17 individuals claimed more than $10,000 worth of physiotherapy in one year

"Sickness is random — there's going to be people within a family that get physio," Romeo-Beehler said.

"But not the entire family."

'Unlimited' coverage often applies to dependents 

The systematic nature of the claims, she said, suggest they could be fraudulent. 

The city has been reining in the health benefits offered to its workers. However, there are still some areas where there's "unlimited" coverage — which often applies to dependents, as well. Romeo-Beehler said the city needs to keep a close eye on these areas. 

The auditor's report notes the area of extended health benefits, which excludes drug costs, has also shot up 68 per cent in the last ten years and now costs the city some $56 million in 2015.

Toronto Auditor General Romeo-Beehler (right) unveiled her findings last Friday at an audit committee meeting where the serious allegation that the city was losing millions due to potential bid-rigging by paving companies took centre stage. (John Rieti/CBC)

It also found $75,000 in overpayments, which the city is hoping to recover from Manulife. The report also criticizes the insurance giant for not doing more to catch abuse. 

"Overall, we found the controls and monitoring of the city's benefit claims ineffective in identifying unusual patterns or potential frauds," the report notes. 

Coun. Josh Matlow said he supports taking a close look at the health plan.

"We need to do things differently," he said, adding some of the abuse is "glaringly obvious."

The auditor issued a series of recommendations to improve the system, which were adopted by the audit committee. 

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