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Update / Statement of Practitioner Services: 2016 (Page 1)

MCIB Does Not Remove or Annotate Claims Proved Fraudulent

Compare the 2007 and 2016 Statements

In 2016 I, the Tuum Est webmaster Georgena Sil filled out the new government form titled Medical Statement Request Application, and sent it to the Medical Care Insurance Branch, which is the payment arm of Saskatchewan Health.  In reply, MCIB furnished a Statement of Practitioner Services going back ten years, from April 2016 to January 2006.

The Statement is a financial record of individual payments made by Medicare to doctors for care provided to a given patient, during the stated time period. Only services covered by Medicare are included. These insured services are itemized, by name of procedure and billing code, in the Saskatchewan Payment Schedule for Insured Services.

The entire 2016 Statement is not reproduced here, just the portion disclosing the Nayar fraud. The fraud ended in January 2007. Thus there is a one-year overlap between the original and updated Statements where fraud activity can be compared (see sidebar).

MCIB redesigned the Statement format. The 2016 version has 27 rows per page, while the 2007 version has 37 rows per page. When comparing the two Statements side by side, the page-tops will therefore start on different dates. But taken as a group, the billings match: Exactly the same billings appear, in the same order, because MCIB policy forbids deleting any entry on a Statement, even after fraud is proven.

A comparison is significant; it translates policy into action in a real-world case. We see that the billings from Drs. Nayar, Khan, Dangor, or Datta were not withdrawn – despite the fact that Nayar and the government both acknowledge the phantom nature of 134 doctor visits; and despite that fact that MCIB ordered an evidence-based recovery of funds. Find a full discussion at Did the MCIB Fulfill its Ruling?

Statement:  Adding a Status Column

To mark the phantom appointments, Tuum Est added its own Status Column on the right side of each Statement page. The size of the Nayar fraud was audacious, and some billing patterns were impudent. We highlight such claims with this color key:

Gray Row Fraud / General case
Yellow Row Fraud / Statutory holiday
Green Row Fraud / Location conflict

The 2016 Statement is verbatim from the original, apart from adding the Status Column and highlight colors, and blocking the patient's health-number. We also clarified the Provider of Service field: A decade ago, GP Dr. Straza practiced at Idylwyld Medical Clinic in Saskatoon. Later he moved to Alberta. When the new Statement was printed, the name Dr. Straza no longer existed in the Saskatchewan Medical Register; therefore the MCIB computer completed the field with the word Unknown. We restored Straza's name.

  • Statement 2016
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Medical Services Report Statement of Practitioners Services Report Generated on: April 14, 2016

  • SHN
  • SIL
  • GEORGENA
  • January 1, 2006
  • to
  • April 13, 2016

Page 1

Type of Practitioner Provider of Service Location of
Practitioner
Location
of Service
Service Date
(D/M/Y)
Type of Service
Billed
Amount
Paid
 
Family Practitioner Nayar, Arun SASKATOON Home 1-Jan-2006 Visit Service $24.00 Fraud
Family Practitioner Nayar, Arun SASKATOON Home 7-Jan-2006 Visit Service $24.00 Fraud
Family Practitioner Straza, Lorne (moved) SASKATOON Office 12-Jan-2006 Surgical Service $15.00  
Family Practitioner Straza, Lorne (moved) SASKATOON Office 12-Jan-2006 Visit Service $26.40  
Family Practitioner Dangor, Abdulla I SASKATOON Home 15-Jan-2006 Visit Service $24.00 Fraud
Family Practitioner Dangor, Abdulla I SASKATOON Home 21-Jan-2006 Visit Service $24.00 Fraud
Family Practitioner Khan, Rukhshanda Jabeen SASKATOON Home 28-Jan-2006 Visit Service $24.00 Fraud
Family Practitioner Khan, Rukhshanda Jabeen SASKATOON Home 4-Feb-2006 Visit Service $24.00 Fraud
Family Practitioner Dangor, Abdulla I SASKATOON Home 11-Feb-2006 Visit Service $24.00 Fraud
Family Practitioner Straza, Lorne (moved) SASKATOON Office 13-Feb-2006 Visit Service $26.40  
Family Practitioner Straza, Lorne (moved) SASKATOON Office 15-Feb-2006 Phone/Fax Service  $4.00  
Family Practitioner Nayar, Arun SASKATOON Home 18-Feb-2006 Visit Service $24.00 Fraud
Family Practitioner Dangor, Abdulla I SASKATOON Home 26-Feb-2006 Visit Service $24.00 Fraud
Family Practitioner Khan, Rukhshanda Jabeen SASKATOON Home 4-Mar-2006 Visit Service $24.00 Fraud
Family Practitioner Dangor, Abdulla I SASKATOON Home 11-Mar-2006 Visit Service $24.00 Fraud
Family Practitioner Khan, Rukhshanda Jabeen SASKATOON Home 18-Mar-2006 Visit Service $24.00 Fraud
Family Practitioner Straza, Lorne (moved) SASKATOON Office 18-Mar-2006 Visit Service $26.40  
Family Practitioner Dangor, Abdulla I SASKATOON Home 25-Mar-2006 Visit Service $24.00 Fraud
Family Practitioner Nayar, Arun SASKATOON Home 1-Apr-2006 Visit Service $24.00 Fraud
Family Practitioner Khan, Rukhshanda Jabeen SASKATOON Home 8-Apr-2006 Visit Service $24.00 Fraud
Family Practitioner Nayar, Arun SASKATOON Home 15-Apr-2006 Visit Service $24.00 Fraud
Family Practitioner Straza, Lorne (moved) SASKATOON Office 19-Apr-2006 Visit Service $26.40  
Family Practitioner Khan, Rukhshanda Jabeen SASKATOON Home 22-Apr-2006 Visit Service $24.00 Fraud
Family Practitioner Dangor, Abdulla I SASKATOON Home 29-Apr-2006 Visit Service $24.00 Fraud
Family Practitioner Dangor, Abdulla I SASKATOON Home 6-May-2006 Visit Service $24.00 Fraud
Family Practitioner Dangor, Abdulla I SASKATOON Home 13-May-2006 Visit Service $24.00 Fraud
Family Practitioner Nayar, Arun SASKATOON Home 21-May-2006 Visit Service $24.00 Fraud
Georgena S. Sil
Saskatoon, Canada
Physicist & Technical Writer
Alumnus: University of British Columbia
TuumEstContact@protonmail.com

Copyright © 2008-2018 Georgena Sil. All Rights Reserved.