Out of country for 15 months-OHIP for childbirth

[mehvish]

So if a person with PR status is out of Canada(ON) for more than one year, he/she is not eligible for OHIP coverage even if the OHIP card they possess is not expired yet. But I have heard, if that person keeps quiet about it and does not mention it to anyone, they can still keep using the OHIP card and have free healthcare. I know of someone who is planning to come just for childbirth and use their health card for the expenses and then leave the country again as they are not planning to live here. That person has done her research about this topic and says that she will not face any problem as she knows people who have been doing this without any problem.
My question is:
1. Is there any way the government can find out about it at all? If yes, then how would they find out?
2. Aren't the drs and obstetricians here in Ontario told to make sure that if a patient is coming in so late in pregnancy like the 7th month, their health card be checked with the health ministry? Is this in anyway a drs responsibility?
3. When a person with PR status enters Canada after 1 year, wouldn't they be questioned at the airport as to why have they not been living in Canada to fulfill the residency requirements and since they have just less than 2 years left, why are they entering the country again?
Waiting for some good answers, thanks.

 

[torontosm]

1. Is there any way the government can find out about it at all? If yes, then how would they find out?
2. Aren't the drs and obstetricians here in Ontario told to make sure that if a patient is coming in so late in pregnancy like the 7th month, their health card be checked with the health ministry? Is this in anyway a drs responsibility?

I was told by a good friend who is a doctor in Ontario that every time your health card is swiped at the doctor's office, they can immediately see when you entered the country last, Based on that alone, I'm sure that suspicions will be raised. Also, bear in mind that even if you don't get "caught" right away, OHIP can always come after you later to force you to reimburse them if they do find out you were not eligible for healthcare.

Finally, think about what you are asking morally. Do you think it is right for other people to bear the cost of your delivery? Ethically, are you ok with this?

 

[zardoz]

http://www.health.gov.on.ca/english/public/pub/ohip/card_fraud.html

OHIP Fraud

The Ministry of Health and Long-Term Care is committed to detecting abuse and misuse of the Ontario health care system

What is OHIP fraud?

It includes :

Someone knowingly using a health card that is not theirs
Someone receiving OHIP services who is aware that as a non-resident of Ontario they are not eligible.
Someone who knowingly gives false information to the ministry to become or continue to be an insured person when they are aware that they are not eligible.
To report suspected cases of abuse, the public may call the ministry at: 1 888 781-5556 Reports can be made anonymously or by sending an e-mail to the ministry at : reportohipfraud@moh.gov.on.ca
Who is eligible for Ontario health insurance coverage?

Generally speaking, Canadian citizens, permanent residents or landed immigrants, convention refugees (protected persons), or a person registered as an Indian under the Indian Act, or others listed in Regulation 552 under the Health Insurance Act are eligible for Ontario health insurance coverage provided they :

Make their primary place of residence in Ontario, and
Are physically present in Ontario for at least 153 days in any 12-month period.
In order to ensure that only eligible Ontario health card holders have access to publicly funded health services, OHIP eligibility assessments are conducted by the ministry on a routine basis.
The ministry investigates each and every allegation it receives regarding potential health insurance abuse.

Ontario health insurance coverage is cancelled where health card holders are unable to prove entitlement to Ontario health insurance coverage. Where fraud is suspected, cases are referred to the Ontario Provincial Police Anti-Rackets Health Fraud Investigation Unit for investigation and possible prosecution.

Under the Criminal Code of Canada Section 380, a person convicted of fraud exceeding $5,000 could be imprisoned up to 10 years. Restitution may also be ordered under the Criminal Code.

April 2009

Enough said...