Fraud and non-compliance: definitions, penalties, and reporting
In 1997 the WSIB announced a Zero Tolerance Strategy to ensure compliance and combat fraud. The Strategy included increased resources, a “tips ”Action Line, and the authority to conduct surveillance. The WSIB will identify noncompliance, fraud and irregularities by workers, employers, providers and suppliers and take appropriate action. This may result in charges under Sec.149 (4) (submitting false or misleading statements) of the Workplace Safety and Insurance Act, or Sec.380 (fraud) of the Criminal Code.
What can I do if I suspect that a patient, an employer, a supplier, or another health care practitioner is not dealing honestly with the WSIB?
You can use our toll-free action line or e-mail address to report suspected cases of non-compliance and fraud.
What steps are taken to protect your identity?
- When reporting fraud or non-compliant behaviour you are not required to provide your name, address, or any other information that may identify you
- Please be aware that under the Freedom of Information and Protection of Privacy Act and the Workplace Safety and Insurance Act any information you provide may be released to people including, but not limited to, the worker, the employer and their representatives
- When e-mailing us directly from the WSIB website, we do not capture your email address. However, information you submit to us using your own e-mail allows for your e-mail address to be tracked.
- Every reasonable effort will be made to protect your personal identity
- Information you submit to us using the Internet is not secure while in transit to us
- You may wish to call our toll-free action line
Call Toll-free: 1-888-SI-LEADS (1-888-745-3237) between 8 a.m. and midnight, Monday to Friday.
E-mail us at: sileads@wsib.on.ca 24 hours a day, 7 days a week.
What constitutes an offence in dealing with WSIB?
It is an offence when a health care provider or supplier intentionally does any of the following:
- Bills for services or goods that are not actually provided.
- Falsifies any aspect of billing submitted (for example, bills for more expensive service than the one actually provided).
- Bills for services that are medically unnecessary
What is the penalty for submitting false or misleading statements?
Conviction can result in the following penalties:
- For an individual: A fine not to exceed $25,000 and/or a jail term of up to six months.
- For a corporation: A fine not to exceed $100,000.
(Sec.158 (1) of the Act)
The court may also order restitution of the full amount of money obtained by commission of the offence (Sec.149 (5) of the Act).
What is the penalty for fraud under the Criminal Code?
Conviction can result in the following penalties:
- Where the value of the fraud exceeds $5000: conviction may result in imprisonment for a term of up to 10 years.
- Penalties may also include: fines, probation, and/or a restitution order.
Would a conviction under the Workplace Safety Insurance Act or the Criminal Code affect my licence to practice?
In cases where a health care practitioner is convicted, the WSIB notifies the appropriate regulatory body and provides a factual summary. The
regulatory body will take whatever action it deems necessary.
Want to get involved in preventing fraud in Canada’s healthcare system?
The Canadian Health Care Anti-Fraud Association acts on behalf of public and private sector healthcare organizations interested in preventing fraud in the Canadian healthcare environment. |
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