Billing the province for dead patients and creating fake prescriptions from deceased and retired doctors — all part of a Toronto pharmacist’s web of deceit.

Using these and other schemes, Amany Hanna bilked more than $200,000 from Ontario’s drug benefit program and was disciplined by the provincial pharmacy regulator.

Hanna is one of 107 health-care professionals found guilty of fake billing during the past five years. Like almost all of them, she kept her licence.

A Star investigation has found that most health-care providers sanctioned by the province’s health regulatory colleges for false and misleading billing are allowed to continue practising, even in cases that resulted in criminal fraud convictions. The 25 regulatory colleges the Star reviewed also include bodies that oversee chiropractors, dentists and optometrists.

Hanna, 49, was the manager and part owner of a small pharmacy next door to Humber River Hospital at Finch Ave. and Hwy. 400.

Following a provincial health ministry audit and a police investigation, Hanna pleaded guilty in 2012 to fraud over $5,000, was given a 12-month conditional sentence and was ordered to pay $60,000 in restitution to the province.

The Ontario College of Pharmacists discipline panel did not revoke her licence. Instead, in Nov. 2014, it issued an 18-month suspension, a reprimand and a requirement to take an ethics course. She was also ordered to pay $20,000 in costs. The discipline panel called Hanna’s conduct “disgraceful, dishonourable and unprofessional.”

Hanna will be eligible to continue working as a pharmacist next year.

Hanna did not respond to the Star’s numerous attempts to contact her, including two detailed letters left at her home and Highland Creek Pharmacy, the pharmacy in Scarborough her husband operates.

At Hanna’s court sentencing hearing in 2012, her lawyer, Marie Henein, said her client’s actions were “financially motivated offences” and came shortly after Hanna’s daughter was diagnosed with relapsing-remitting multiple sclerosis. Henein said treatment for the disease was costing Hanna and her husband more than $40,000 a year.

Henein also told the court that Hanna had no criminal record, or any complaints or issues with the Ontario College of Pharmacists prior to the charges.

Hanna and her husband own three cars: a black 2014 Mercedes, a grey 2013 Mercedes and a white 2013 BMW. The couple own two oceanfront condos in Florida, including one in Miami valued at $1.2 million. In Toronto, the family lives in an upscale Willowdale home with a two-car garage.

Hanna has not paid $42,000 in legal bills to the law firm Torkin Manes, which represented her at the College of Pharmacists. Torkin Manes, a highly regarded firm, has been trying for more than 10 months to get Hanna to pay her bill, according to a statement of claim filed in Ontario Superior Court.

The provincial health ministry audit, which covered nearly a three-year period, found that Hanna submitted false claims to the Ontario Drug Benefit Program for 20 different drug products that were not dispensed to patients. The ODBP is a provincially funded program that helps cover the cost of prescription medications, primarily for seniors. The ministry found the total fraud amounted to $202,784.55.

Here are the highlights of the provincial health ministry’s audit of Hanna’s pharmacy:

65 claims were made for dispensing products to seven dead patients.

More than 3,500 claims with “incorrect” identifying information about the prescribing medical practitioner, including 16 claims from a doctor whose licence to practise had been revoked six years earlier.

Two drug refill claims that came from a doctor who died 10 years earlier.

118 claims for Pico-Salax, a medication used to clean the bowels before a colonoscopy, for a patient who had not been prescribed the drug.

55 claims for the antibiotic Biaxin XL for a patient who had been prescribed the drug just three times.

12 claims for Enbrel, a drug used to treat rheumatoid arthritis and other diseases, over a four-month period after the patient had stopped taking the medication.

More than $31,000 worth of claims for prescription reviews with patients without any supporting documentation, such as signatures or dates. In one case, Hanna told inspectors she was “sure” she had conducted a review session with a patient two weeks after the patient had died.

Dealing down

Health colleges routinely cut deals to shorten suspensions for members caught making fake billings if certain conditions are met, the Star found.

These conditions include ethics and accounting courses, remedial training and requiring the health professional to pay the college’s costs in building the discipline case.

Most professionals disciplined for false or misleading billing were allowed to continue practising after a suspension ranging anywhere from one month to 18 months.

While most of the discipline summaries posted on the regulatory colleges’ websites contain the allegations and punishments handed out, they often lacked specific details showing how the members carried out their fake billing.

Hanna’s profile on the Ontario College of Pharmacists’ website, for example, contains no information about her fake prescriptions for dead patients. The Star had to ask the college for additional documents used during Hanna’s disciplinary hearing to learn the full extent of her fraud.

Less than half of the public discipline decisions show the dollar amount of the false bills. For those that do, the amounts range from a few hundred to several hundreds of thousands of dollars.

Health professions in Ontario are self-governing, like teachers and lawyers. Each profession has a regulatory college that licenses, oversees and disciplines its members.

This investigation did not examine discipline decisions issued by the College of Physicians and Surgeons, as previous Star stories have focused on doctors. This time, the Star focused on the other 25 health regulatory colleges in Ontario.

Medical malpractice lawyer Paul Harte says that over the past decade, he believes discipline decisions have leaned too far toward emphasizing remediation at the expense of accountability.

“If there were more revocations, you’d expect fewer health-care practitioners who would be willing to risk their licence to make a few bucks,” said Harte.

“It is truly a balancing act. I don’t think you can have an absolute zero tolerance rule, but . . . I think there’s certainly room for the pendulum to swing back toward accountability and general deterrence.”

Colleges say that licence revocations are reserved for the most egregious offenders and those members who have a history of discipline. Under the Regulated Health Professions Act, the legislation that governs Ontario’s health workers, a revocation of five years is mandatory for certain types of sexual abuse.

There is no mandatory minimum penalty a discipline panel must impose on other professional misconduct, such as the fake billing in many of the cases the Star studied.

Marshall Moleschi, registrar of the Ontario College of Pharmacists, said he is confident that “we uphold our mandate to protect the public interest.”

“With respect to this particular matter the assurance to the public is not only found in the individual outcomes of disciplinary cases, but also the transparent disclosure of all disciplinary outcomes on the public register,” Moleschi said in an email.

“Any disciplinary finding becomes part of that member’s permanent profile and displayed on the public register which is accessed through the college website. Providing this information allows the public to make informed decisions regarding their health-care provider.”

These are a few examples of Ontario health-care providers who were caught by their regulatory colleges issuing false or misleading billings. All kept their licences to practise.

*All findings come from publicly available agreed statements of facts.

Monir Mina

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Mina, a dental surgeon in St. Thomas, Ont., billed more than $32,000 for surgery that was “not justified by the records over the course of four months, was aggressive and was done for his own financial gain,” according to the Royal College of Dental Surgeons.

The college said he also took “unnecessary” X-rays on eight separate occasions, “thereby repeatedly and needlessly exposing his patient to radiation,” and diagnosed inflammation of the tissue around the teeth without a complete exam. In addition, periodontal measurements taken by Mina did not support the extent of the surgery or the use of bone graft procedures.

Discipline: Three-month suspension; reprimand; ordered to take ethics course and periodontics course; practice to be monitored for 24 months; $1,000 in costs.

Response: In an interview with the Star, Mina said the billing was done by a former business partner, whom he declined to name.

“It was a friend of mine and he had the majority of the shares. He was the managing partner and he was billing a lot of things electronically,” said Mina, adding that it happened when he practiced in Toronto.

He said he was working at five different offices at the time and that he “should have kept my eyes more open.”

Joseph Arcuri

Arcuri, a chiropractor in Niagara Falls, was first disciplined in 2010 after his clinic submitted 374 claims, amounting to $24,000, for massage therapy that was never provided. His initial 12-month suspension was reduced to six months when he completed a record-keeping workshop and an ethics exam.

Arcuri hired another chiropractor to see patients during his suspension, but that chiropractor became suspicious that Arcuri was still seeing patients.

College investigators following up found that Arcuri made claims to an insurer for patient treatments under the other chiropractor’s name. Those treatments were bogus.

When investigators met with Arcuri, they asked to see invoices, patient ledgers and statements of accounts for 15 patients, but Arcuri said he didn’t keep that information. When the investigators asked to see his appointment book, Arcuri said he was “locked out” of his Google calendar. When they asked for the 15 patient files to be handed over, Arcuri simply left his office.

The investigators later returned with a search warrant for the 15 patient files, but when Arcuri handed them over, nine files were missing and had been replaced with other files. After Arcuri said he didn’t know where the missing files were, the investigators searched the building and found two boxes of confidential patient files in a basement accessible to a next-door pizza restaurant. They could not find the nine missing files. Despite repeated requests, Arcuri never produced them for the college.

Discipline: 12-month suspension, which was lowered to seven months after Arcuri complied with various conditions, including another record-keeping course and ethics exam; costs of $10,000.

Response: The Star visited Arcuri at his Niagara Falls clinic in an attempt to discuss the allegations, but he declined to comment.

“You have no story really with me. You might be better finding another chiropractor that might respond to your questions,” he said.

Frank Stepec

When a patient had one appointment with Toronto optometrist Frank Stepec, he billed OHIP twice. Stepec did that with 32 patients, according to court documents. For another 25 patients, Stepec billed OHIP for multiple minor assessments that were not provided.

In total, Stepec improperly billed OHIP about $30,000 between Jan. 2007 and Nov. 2009.

He pleaded guilty in criminal court to two counts of fraud under $5,000, was given three months house arrest and nine months probation. He was also ordered to pay $30,000 in restitution to OHIP, which he did. Two of his employees were also charged in relation to the fraud, but those charges were dropped.

Stepec’s lawyer, Richard Shekter, told court Stepec came to him for help in making restitution to OHIP three months prior to his client’s arrest. Shekter said his client’s behaviour was “completely out of character” and that Stepec was “truly remorseful.”

Discipline: The College of Optometrists of Ontario issued Stepec a two-month suspension; reprimand; $7,500 in costs.

Response: In an interview with the Star outside his Etobicoke office, Stepec said he proactively took steps to pay the money back because he “just had enough.”

Stepec stressed that he did not bill for patients he did not see. “I saw everybody. It’s just that I would bill later on.”

“I’m a big enough guy to say yeah, that’s what I did. You know what I mean? Let’s go through the system, let’s get it done and all the rest. Obviously the college gets involved because it’s a criminal case,” he said.

Marni Blumfald

In one case, the College of Physiotherapists of Ontario disciplined one of its members because of what she did privately.

Blumfald, a Thornhill physiotherapist, forged the signatures of other health-care providers on fake claims for health services and products for herself that she never received. Blumfald received more than $10,000 in payments from her insurance company, Chambers of Commerce Group Insurance Plan, for these false claims between 2009 and 2011.

While she submitted the claims for herself outside her physiotherapy practice, the college discipline panel stated that it felt it “had an obligation to deter the profession at large” and to show the public that the profession “takes its role as a regulator seriously.”

Discipline: Reprimand; six-month suspension, which was lowered to three months when Blumfald took an ethics course, paid $3,000 in costs to the college and allowed the college to monitor her practice for three years.

Response: Blumfald stressed to the Star that she did not submit the false bills as part of her practice and repaid her insurance company.

“It was my own personal health benefits,” she said. “If I went to physio or I went to massage, I got receipts. It was my stuff I submitted. Then my insurance company audited me and then my college found out and went after me.”

In a later email to the Star, Blumfald stated: “All I can tell you is: I made a mistake. I paid for it. And I am very thankful to be continuing to provide my therapy services to individuals in need. As I’m a great therapist and love what I do.”

Time frame: 2010-2014

288,000: approximate number of regulated health-care professionals in Ontario, including doctors

26: number of health regulatory colleges in Ontario

107: number of health-care professionals found guilty of false or misleading billing*

99: number of suspensions issued to health-care providers for false or misleading billing

7: number of licences revoked for false or misleading billing

6: number of health-care professionals who resigned while facing allegations of false or misleading billing

1: number of health-care professionals given only reprimands for false and misleading billing

*Discipline data from the College of Physicians and Surgeons of Ontario is excluded.