Report wrongdoing (a person or situation)

We see to it that only those persons who are entitled receive state-paid coverage under the Québec Health Insurance Plan. This is why we examine potentially fraudulent actions that are reported to us. In certain cases, we will also conduct investigations.

Examples

You can report wrongdoing on the part of someone if they:

• have a Health Insurance Card but they:
  • are not domiciled in Québec
  • spend 183 days or more outside Québec during a 12-month period
  • have a status that renders them ineligible
• lend, entrust, give away, sell or modify their Health Insurance Card
• register for the Public Prescription Drug Insurance Plan even though they qualify for private group insurance
• have a Health Insurance Card that does not match their name
• provide RAMQ with false information

You may also report any other situation concerning health insurance or prescription drug insurance.

We ensure that health professionals are properly remunerated in keeping with their respective professional agreements. If you witness a healthcare professional doing something questionable or breaching a law or regulation, you can report this situation. This applies to:

• General practitioners (family doctors)
• Medical specialists
• Pharmacists
• Dentists
• Optometrists
• Oral and maxillofacial surgeons
• Third parties in charge of billing such as billing agencies

Examples

• Health professionals who bill RAMQ for a service that was never provided
• False information provided by health professionals so that they may obtain a payment to which they are not entitled or to obtain a higher payment
• If you are a health professional, inappropriate billing by colleagues

If you witness an irregular practice or situation in contravention of a law or regulation, you can report this situation. This applies to:

• Audioprosthetists
• Ocularists
• Denturologists
• Distributors of assistive listening devices
• Orthotics and prosthetics laboratories
• Facilities providing hearing, physical or visual rehabilitation

Examples

• Providers who bill RAMQ for a tailor-made device even though they actually provided a mass-produced device
• Providers who bill RAMQ for a repair that is covered under a warranty
• Providers who bill RAMQ for goods that they receive at no cost from another supplier
• Providers who supply insured persons with a device lacking the required basic components
• Providers who bill labour time not done

Did you pay for any accessory costs? Accessory costs are related to covered services, such as medical, dental, optometric or pharmaceutical services. You can report persons, pharmacies or clinics having billed these fees. This applies to:

• Physicians
• Dentists
• Optometrists
• Pharmacists

Examples

• Nurses in private clinics, where a physician practices, charge for blood tests
• Physicians charge a fee to perform a simple test (strep test, urine dipstick test or blood sugar test, for example)
• Physicians who charge a fee to use a required supply, such as an anesthetic agent or ophthalmic drops
• Medical clinics that charge to create a patient file or to provide access to a physician

If you witness any reprehensible commercial practices, irregular behaviours or a potentially fraudulent acts in breach of a law or regulation administered by RAMQ, you can report these situations. This applies to:

• Drug manufacturers
• Drug wholesalers
• Pharmacy groups or chains
• Pharmacists
• Authorized prescribers
• Staff in a clinic or pharmacy
• Group insurers or administrators of an employee benefit plan

Examples

• Pharmacists who fail to hand you a detailed invoice
• Private insurers who oblige clients to go to a chosen pharmacy in order to be reimbursed for their prescription drugs
• Questionable business models used by drug manufacturers or wholesalers
• Rebates given on drugs other that those allowed under the Regulation respecting the conditions governing the accreditation of manufacturers and wholesalers of medications
• Agreements promoting the purchase of certain drugs on the List of Medications or favouring certain accredited manufacturers in return for gratuities, rebates or discounts
• Accredited drug manufacturers or wholesalers not complying with the accreditation conditions
• Inappropriate use by owner pharmacists of professional allowances received from generic drug manufacturers (drug purchases or advertisements, for example)
• False information sent to RAMQ to allow persons to obtain a reimbursement for drugs to which they are not entitled