Health Card Fraud

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

It includes :

• Someone knowingly using a health card that is not theirs
• Someone knowingly receiving OHIP services becoming a non-resident of Ontario
• Someone who has stolen another person's identity in order to receive OHIP benefits
• Someone who knowingly gives false information to the ministry to become or continue to be an insured person

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

Generally speaking, Canadian citizens, permanent residents or landed immigrants, convention refugees, or a person registered as an Indian under the Indian Act, or others listed in Regulation 552 who :

• Make their permanent and principal home 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, eligibility assessments are conducted by the ministry on a routine basis under the authority of the
Health Insurance Act.

The ministry investigates each and every allegation it receives regarding health insurance abuse.

Ontario health insurance coverage is cancelled where health card holders are unable to prove entitlement to Ontario health insurance. 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.

A person, who has been convicted of a provincial offence under the Health Insurance Act, is subject to a penalty of up to $25,000 and/or jail up to 12 months for a first offence. For a subsequent offence the penalty is a fine of up to $50,000 and/or jail up to 12 months. Under the Health Insurance Act, a court can also order a person convicted, to pay compensation or make restitution to a person who suffers a loss as a result of the offence.

For more information, refer to the fact sheet "OHIP Eligibility".

June 2005