Coerced to change medical opinion to reduce number of claims: Statement
A lawsuit filed against Ontario’s Workplace Safety and Insurance Board (WSIB) is alleging the unlawful dismissal of Brenda Steinnagel, a doctor, is indicative of a broader pattern of fraud within the workers’ compensation system.
Before she was fired, Steinnagel worked for Workplace Health & Cost Solutions (WHCS) in Vaughan, Ont. In her work, Steinnagel provided external medical consultations to assist WSIB case managers in adjudicating claims filed by workers. Steinnagel consulted on claims to determine whether workers’ injuries were connected to a workplace accident and, therefore, eligible for benefits.
In a statement of claim filed with the Ontario Superior Court of Justice in July, Steinnagel alleged WSIB attempted to coerce her to change her medical opinion about an injured worker. When she refused to do so, WSIB pressured WHCS to fire her, she said.
"In a desperate effort to reduce claims paid out, WSIB and WHCS have been conspiring to deny legitimate claims in a shocking display of arrogance and corruption," read the statement of claim, referencing WSIB’s unfunded liability. "They pressured Dr. Steinnagel over a period of months to reverse her medical opinion on a high-cost case. When she refused, she was fired."
Contractors — including WHCS — were given orders to reduce the number of claims paid out to workers, even if that meant benefits may be unfairly denied, according to the statement of claim.
"Even more disturbing, this fraud upon the public has been repeated by WSIB and WHCS in other cases."
At least one other "unco-operative" doctor was pressured to change the wording on an opinion she drafted, said the claim. That incident ultimately resulted in the doctor quitting her job.
Because WSIB oversees a roster of doctors approved to carry out its assessments, Steinnagel alleged she is now effectively unemployable in her field. She is seeking more than $1.3 million in damages from the WSIB and more than $1.8 million from WHCS, as well as a declaration that she was wrongfully terminated.
WSIB and WHCS vehemently denied the allegations.
"There is no truth to Dr. Steinnagel’s allegations and we deny acting wrongfully in any way," said WSIB senior public affairs consultant Christine Arnott. "The WSIB will vigorously defend the lawsuit."
The WSIB receives more than 200,000 new claims each year from injured and ill workers. It says upwards of $2.6 billion in benefits are paid out annually.
Because the issue is still before the courts, however, WSIB declined to provide any further comment.
WHCS also declined to comment, with Gred McGinnis — a lawyer at Mathews, Dinsdale & Clark in Toronto representing WHCS — saying only "Steinnagel is an apparently disgruntled former employee of WHCS, who has brought an action against WHCS and WSIB following the end of her employment. The claims she has made about improper conduct are without merit, and we have brought a motion to the court to strike out many parts of the claim."
The motion to strike much of the claim was to be heard in court on Oct. 26, with the lawsuit itself expected to follow in November.
Significant protections are in place to prevent fraud within the workers’ compensation system, according to Joanne Woodward Fraser, senior communications advisor, media communications and marketing division at the Ministry of Health and Long-Term Care.
Using the Ontario Health Insurance Plan (OHIP) as an example, Woodward Fraser said the ministry has applied a proactive approach to deter fraud and reduce any losses.
"We maintain a valued partnership with the Ontario Provincial Police’s Health Fraud Investigation Unit (OPP HFIU) for investigation of potential cases of fraudulent activity," she said. "We have also increased our investment in staff engaged in activities supporting risk management and fraud control initiatives."
All suspected cases of fraud go through a triage process, Woodward Fraser said. These cases are reviewed and evaluated against ministry resources before being sent onward to the OPP HFIU.
Part of that review and evaluation process includes verification letters randomly generated by a computer system. These letters are sent to recipients of health-care services to verify billing accuracy.
Additionally, claim payments are analyzed to detect patterns of activity the ministry has identified as problematic.
The Fraud Awareness and Management (FAM) section is the central point of contact within the ministry to coordinate anti-health fraud activities. The FAM section operates within the Risk Management and Fraud Control Union of the ministry’s Accounting Policy and Financial Reporting Branch.
In an effort to make these resources even more available to the public, toll-free fraud hotlines are available to report potential fraud, Woodward Fraser said. A similar line is available for health-care providers.
The statement of claim filed by Steinnagel, however, calls for more stringent investigations into the possibility of a broader pattern of fraud within the workers’ compensation system.
"The misconduct against Dr. Steinnagel is part of a long pattern of such fraud and intimidation of those who get in the way of their fraud… the defendants’ conduct was harsh, vindictive, reprehensible and malicious," the claim read.
"The misconduct by WSIB and WHCS was planned and deliberate and formed a protracted corporate conspiracy against Dr. Steinnagel."