Toronto’s Auditor General is suggesting the city adapt a number of recommendations after a recent audit on employee extended health care benefits revealed huge reimbursement costs on massages, physiotherapy and in one case, orthotics.
The audit conducted by Beverly Romeo-Beehler’s office says the city’s annual cost on employee extended health care benefits (excluding drug benefits) has increased 68 per cent over the 10 years from $33 million in 2006 to $56 million in 2015.
“Overall, we found the controls and monitoring of the city’s benefit claims ineffective in identifying unusual patterns or potential frauds,” said Romeo-Beehler in Friday’s summary released to city council at the audit committee meeting. “In 2015, the City spent approximately $229 million to provide employee benefits including health, dental, long-term disability and employee life insurance, of which approximately $56 million was for extended health care benefits (excluding drug benefits).”
Some of the “potential benefits waste or abuse” in the summary included:
- nine employees and their family members claiming a number of medical braces between $13,000 and $38,000 over the three years.
- An employee with three dependents being reimbursed $28,500 for close to 60 pairs of orthotics over three years.
- 17 individuals each receiving $10,000 or more for physiotherapy reimbursement within a year.
- An employee with four family members submitting physiotherapy claims totalling about $23,000 each consecutive year, for three years.
The Auditor General also says that in their “limited sample” of claims, they identified two medical supply and equipment providers with suspicious activities, which have been referred to then-benefits provider Manulife for investigation.
Romeo-Beehler is urging that the city take on more oversight on the benefit claims of city staff through 16 recommendations provided in the 2017 AG’s report to improve controls in the hopes of detecting and preventing future misuse and reducing costs. The recommendations have been adopted by the audit committee.
Prior to the release of the report, Toronto has since moved on from using Manulife to administer the city’s health and dental benefits and has contracted a new benefits administrator.
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