Ontario Automobile Anti-Fraud Task ForceSteering Committee July 2012 Status Update

A Private Investigation Firm Perspective

Introduction

The Council of Private Investigators-Ontario is an Ontario non-profit corporation whose purposeis to serve the interests of licensed private investigators in the province. As the recognizedmember of the Canadian Association of Private Investigators representing Ontario, we appreciatethe opportunity to provide feedback to the July 2012 Ontario Automobile Anti-Fraud Task ForceSteering Committee Status Update. We concur with the four key areas previously identified inthe December 2011 Ontario Automobile Insurance Anti-Fraud Task Force Interim Report(Prevention, Detection, Investigation and Enforcement) and would like to share with you ourperspective as Private Investigators with law enforcement and criminal investigationbackground.

Relevant issues contained in the Status Update will be first addressed followed by ourperspective on how the role of Ontario Private Investigation firms can readily be expanded tocombat health care fraudulent activities. Finally, we will provide some suggestions to achieveeducational, certification and maintenance of competence goals for Ontario Private Investigators,insurance and health care professionals.

Establishment of a dedicated fraud investigation unit (pages 36 and 37)

We will not repeat here the observations made in Chapter 3 of the 2011 Auditor General reportregarding FSCO. We suggest that while FSCO is an important player, the investigative andenforcement capacity must remain with the Ministry of the Solicitor General who already isresponsible for the OPP and Special Investigation Unit. In addition to using HCAI as a tool tofight fraud, the MSG already possesses the necessary core competency to investigate criminalactivities using sophisticated data analytic tools and database. Furthermore, they also possess theexperience to address privacy issues. We encourage having both central and regional insurancefraud control units to coordinate anti-fraud efforts in a matter similar to those developed by theUnited States Health & Human Services (HHS) Office of Investigator General (OIG) whoconduct criminal, civil and administrative investigations of fraud and misconduct related to HHSprograms, operations and beneficiaries.

In the July 2012 Status Update, the Steering Committee wrote: "We are encouraged by therecent actions that have been taken by Ontario law enforcement, and by the cooperation withindustry that has apparently played a role in some of these actions. " While we welcome thisnew development, it must be considered how this may be implemented at a time when the PublicSector is facing serious financial constraints. We also believe that further initiatives canstrengthen the cooperation that now exists, and that such measures can be implemented relativelyquickly and effectively. An important and fiscally realistic initiative is to fully utilize the privateinvestigation industry that already has strong ties with both the insurance industry and Ontariolaw enforcement in this process. The role of private investigators can be easily expanded to thefield of health care fraud investigation in a timely fashion.

It is essential to establish a central control unit that utilizes all available police and privateinvestigator resources for the common goal of reducing automobile insurance and related healthcare fraudulent activities in Ontario.

In the July 2012 Status Update, the Steering Committee wrote: "There are two particular areasthat have been identified as having potential to assist the investigation of criminal acts. The firsthas to do with the transfer of evidence from investigators in insurance companies, IBC, or FSCOto law enforcement, and the second relates to the involvement of Provincial Crown counsel. " Weagree with this statement, but would point out that Private Investigators can lay «PrivateInformation" directly to the Crown counsel which would decrease the dependency upon anexpensive and overstretched Police Services.

Of note, investigators working in insurance companies represent only a minute fraction of theprivate investigators currently active in the insurance field. It should be noted that commentsrelating to access to relevant databases by Private Investigators is crucial for this endeavor alongwith civil immunity provisions addressed later in the report. We also favor developing a HealthCare Fraud Private Investigation Certification Program for Licensed Private Investigator.

Transfer of evidence to law enforcement (pages 37 and 38)

In the July 2012 Status Update, the Steering Committee wrote: "We believe it would be veryhelpful if police forces, particularly in the GTA and with the cooperation of the DPP, wouldexplore the feasibility of developing a joint force collaboration strategy to create publicawareness, develop a law enforcement response and provide tactical priority-drivenenforcement. We hope that in our final report we are able to report that such an initiative isunder way. " We respectfully suggest that this vision is not realistic given that municipalitieshave no interest or fmancial resources to engage in such a venture that will be publicallyperceived as primarily beneficial to the private insurance industry.

In times of fiscal restraints, collaboration between Private Investigators and Crown Counsel isnot only practical but essential if one is serious about addressing the Ontario automobile fraudsituation effectively. The "Private Information" process executed by qualified individuals is thevehicle to achieve success.

Continuity of provincial Crown counsel (p.38-39)

In the July 2012 Status Update, the Steering Committee wrote: "While we do not believe that'dedicated' Crown counsel are required or essential, we do recognize that investigations taketime, that Crown counsel are available to provide pre-charge advice to police when necessary,and that once charges are laid the continuity of Crown counsel is important. We urge theMinistry of the Attorney General to continue to ensure continuity wherever possible andparticularly in large, complex fraud cases. " We agree with this statement but also recommendthat private investigators be included in this process.

Related issues: privacy and civil immunity (p.39-41)

We agree with the statements made in the July 2012 Status Update. We urge the SteeringCommittee that provisions that are suggested be expanded to include activities under the PrivateSecurity and Investigative Services Act, 20051•

Development of a Health Care Fraud Investigation Certification Program

1 For more information regarding licensing requirements and code of conduct, please consult the Private Securityand Investigative Services Branch Ministry of Community Safety and Correctional Services

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Given the lack of private and public sector investigators with experience in investigating HealthCare Fraud, it is highly recommended that specialty training be developed. We envisiondeveloping a roster of Certified Health Care Fraud Investigators leading investigation for theprimary purpose of criminal prosecution. A Health Care Fraud Prevention program for insuranceadjusters and HCAl service providers and vendors is highly recommended to reduce current ratesof fraudulent activities.

We are also at the disposal of the Anti-Fraud Task Force Steering Committee for futureconsultation as Private Investigators are already central to the fight against fraudulent activitiesin the Ontario Automobile Insurance System.

Sincerely,

~Debbra Macdonald, C.I.I.PresidentCouncil of Private Investigators-Ontario

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