Several fraudulent benefits claims worthy of dismissal
A worker with a key financial role for a public servants’ union has lost her job for filing numerous false and misleading claims for benefits.
The women started working for the Canada Employment and Immigration Union (CEIU) in July 2010 as the assistant to the director of finance and administration. In late 2015, the director of finance went on a leave of absence and the worker took over some of the director’s duties, such as managing the budgets, paying its credit cards, signing cheques and auditing financial statements for the regions.
In February 2016, the CEIU was placed under trusteeship and the employee was appointed as the acting director of finance and administration for a few months until a new permanent director was named.
In early February 2017, the CEIU’s insurance broker told the HR manager that an audit of the worker’s insurance claims had found she had committed fraud.
The broker passed along the results of the investigation that found 11 claim submissions for services that hadn’t been performed as submitted, six that were misrepresented and 25 with inflated charges. It had asked the employee to provide receipts for the claims, but she was only able to do so for a handful.
Several of the claims involved payment for appointments that were “no-shows” and a few were for which the worker paid with cheques that bounced.
The false and misrepresented claims totalled $2,493 and most were from 2016 — the plan required members to keep receipts for 12 months following submission to determine eligibility or in case of an audit — though some went back as far as 2011.
Since all of the claims had been submitted online, the worker had been barred from submitting claims electronically.
The CEIU administrator met with the worker to discuss the claims and the employee said she “must have messed up.” She explained that sometimes she put in different dates for chiropractic treatments on the same day and combined massage receipts into one claim for “little amounts.” She also said she had trouble submitting claims for her daughter because she was also covered by her ex-husband’s plan — however, some of her daughter’s treatments she had claimed weren’t covered at all under the CEIU plan.
The women maintained that she had made mistakes and hadn’t stolen anything.
The administrator didn’t see any evidence to support the idea that the worker had made an honest mistake on all the claims, particularly since she didn’t notify the CEIU about the audit or removal of her electronic submission privileges. A short time later, the CEIU terminated her employment for benefit fraud and breach of trust.
The arbitrator noted that the CEIU relied mostly on the insurance provider’s audit and its own investigation consisted only of a short meeting with the employee. However, it also noted that someone in her role with CEIU would know the importance of not seeking reimbursement without the correct supporting paperwork.
The arbitrator found there was clear evidence of dishonesty on the worker’s part — she didn’t pay the service providers after certain cheques bounced and instead kept the money after filing the claims. This wasn’t a mistake, but rather enriching herself at the expense of both the service providers and the insurers. In these instances, the worker sought payment for services she hadn’t paid for, which provided context when looking at the other challenged claims, said the arbitrator.
Many of the other claims were for services that weren’t covered, which the employee chalked up to mistakes or “sloppiness,” but the arbitrator disagreed.
The misrepresented claims showed a pattern of dishonesty deserving of discipline, the arbitrator said, adding that her position in an important financial role meant such dishonesty was serious and warranting dismissal.
“It is inconsistent with [the employee’s] own job duties to seek reimbursement without the receipts to back it up,” said the arbitrator.
Reference: COPE and CEIU. Laura Trachuk – arbitrator. Charles Hofley, Melissa Bastarache, John Gordon for employer. Glenn Wheeler, Sharon Barbour, Bert Poulin for employee. June 16, 2019. 2019 CarswellOnt 9799
