Stelfox Henry Thomas, Redelmeier Donald A
Department of Medicine, University of Toronto, Toronto, ON.
CMAJ. 2003 Jul 22;169(2):118-9.
Health insurance fraud is a potential source of expense, injustice and adverse events in medical care. We examined one type of such fraud: false claims for prescription benefits after the death of the beneficiary. Of 335,536 elderly people in Ontario who died between Jan. 1, 1991, and Jan. 1, 1997, we identified 113 for whom 1 or more prescription drug benefit claims (about 1 per 3000 deaths) were submitted more than 1 year after their death. Claims for expensive medications were rare, as were those for addictive medications. Our findings suggest that this type of health care fraud occurs infrequently and that countermeasures are unlikely to substantially reduce medication abuse in Canada.
医疗保险欺诈是医疗保健中费用、不公正和不良事件的一个潜在来源。我们研究了其中一种欺诈行为：受益人死亡后对处方药福利的虚假索赔。在1991年1月1日至1997年1月1日期间安大略省死亡的335536名老年人中，我们识别出113人，他们在死亡1年多后提交了1项或更多的处方药福利索赔（约每3000例死亡中有1例）。昂贵药物的索赔很少见，成瘾性药物的索赔也是如此。我们的研究结果表明，这种医疗保健欺诈行为很少发生，而且在加拿大，应对措施不太可能大幅减少药物滥用。
