News / Toronto

Health Ministry urged to crack down on ‘problematic’ doctor billing

Ontario auditor general Bonnie Lysyk called on the Health Ministry to improve oversight of physician billings and payment models.

Auditor general Bonnie Lysyk says the Health Ministry has not been doing enough to investigate inappropriate or anomalous billings from doctors.

Nathan Denette / THE CANADIAN PRESS FILE

Auditor general Bonnie Lysyk says the Health Ministry has not been doing enough to investigate inappropriate or anomalous billings from doctors.

Ontario needs to get tough on physicians who are inappropriately billing OHIP, the province’s auditor general says.

In her annual report, released Wednesday, auditor Bonnie Lysyk called on the Health Ministry to improve oversight of physician billings and payment models.

She said the ministry has not been doing enough to investigate inappropriate or anomalous billings and does not have a cost-effective way of recovering overpayments. Among examples of curious billings cited in the report:

  • Nine doctors claimed to work more than 360 days in 2015/16, including six who submitted billings for 366 days. (There was an extra day in 2016 because it was a leap year.)
  • Some specialties see huge variances in the amounts individual specialists bill OHIP. Differences between the median and 90th percentile gross payments ranged from $460,000 to $713,000 for the five specialties with the largest variances.
  • One cardiologist billed $2.5 million in 2014/15 and performed more than six times the number of services rendered by the average cardiologist.

The report said that since the beginning of 2013, the ministry has not proactively pursued recovering of overpayments.

“The ministry needs to investigate problematic physician billings and put in place a cost-effective enforcement mechanism to recover inappropriate payments from physicians,” Lysyk told a news conference.

The auditor also found problems with a patient-enrolment payment model adopted by the province about a decade ago. Last year, it cost $522 million more than it would have under the traditional fee-for-service model. That’s in part because 1.8 million patients enrolled in these group practices did not see their physicians during the year, yet the doctors were paid $243 million for having them enrolled.

The audit found that physicians in many group practices generally worked between 3.4 and four days a week, and did not work the number of weeknight or weekend hours required by the ministry.

At the same time, 52 per cent of Ontarians had difficulty obtaining medical care in the evening, on the weekend or on a public holiday without going to a hospital emergency department, a ministry survey found.

Lysyk questioned why taxpayers are footing so much of the bill for physician medical liability insurance via the Canadian Medical Protective Association. The province has more than doubled its payments for this insurance over the last three years, forking out $329 million this year, up from $145 million in 2013.

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