Ontario must reassure public on top doctors’ billing

Posted on January 3, 2017 in Health Delivery System

TheStar.com – Opinion/Editorials – It’s high time to get to the bottom of an Ontario medical mystery: how can a single doctor bill for 100,000 patients in a single year?’
Jan. 2, 2017.   Editorial

It’s high time to get to the bottom of an Ontario medical mystery: how can a single doctor bill for 100,000 patients in a single year? And how can another doctor justify billing OHIP for $7 million in the same year?

These are two of the most eye-popping findings taken from an audit conducted by the provincial health ministry and reported last week by the Star’s Theresa Boyle.

The audit found that the province’s 12 top-billing doctors received payments averaging $4 million apiece in 2014-15. Six of them allegedly charged for “services not rendered,” five of them “upcoded” (or billed for procedures that cost more than they should), and three charged for services judged to be “medically unnecessary.” Six claimed to have worked for 356 days or more in the one-year period, according to ministry documents.

All are specialists in such fields as ophthalmology, radiology and cardiology. None of their names are included in the audit report, despite a ruling last year by the province’s privacy commissioner that the identity of the top medical billers should be made public.

It’s not clear what action will follow the audit report. It could involve demanding repayment of excessive fees, action by the doctors’ professional college, referral to the review board that resolves disputes over physicians’ payments, or even referral to police for possible fraud.

But it is clear that Ontarians deserve answers in the face of credible information that, at the very least, some doctors are billing enormous amounts for procedures that auditors find to be highly questionable – if not outright fraudulent.

The Ontario Medical Association has been quick to point out that the doctors involved deserve a fair process before anyone jumps to the conclusion that they have done anything wrong. And it notes that medical billing is complex and doctors’ practices vary widely.

The OMA is right about that, but the people who rely on OHIP (that is to say, all of us) are also right to demand clear explanations of where our tax dollars are going. Ontario doctors collectively bill about $11 billion a year, and we need reassurance that it is being well spent.

A couple of other things are also true. There are about 30,000 doctors in the province, and the audit report involves a miniscule fraction of the most highly paid. And, as always, we should remind ourselves that billing does not equal income; doctors must pay staff salaries, rent and other expenses out of what they bill OHIP.

All that said, what looks very much like excessive billing by some doctors can only raise eyebrows at a time when Ontario is struggling to keep up with growing demand for medical services, and doctors themselves are demanding a better deal from the province.

It also strengthens the argument for making public how much individual doctors bill the province for their services.

Doctors hate the idea, but it’s been done routinely in two other provinces for many years. And last June Ontario’s privacy watchdog endorsed making public the names of the province’s top billers, their specialties and how much each receives from the public.

John Higgins, an adjudicator for the Office of the Information and Privacy Commissioner, ruled in response to a freedom of information request by the Star that “the concept of transparency, and in particular, the closely related goal of accountability, requires the identification of parties who receive substantial payments from the public purse.”

It was a well-reasoned decision, and it seems even more justified now that we have a better idea of just how substantial some of the payments have been. Unfortunately, though, the OMA has challenged the ruling in the courts.

The public interest would be better served by shining a light on medical billing and quickly reassuring Ontarians that precious health dollars are being properly spent.

< https://www.thestar.com/opinion/editorials/2017/01/02/ontario-must-reassure-public-on-top-doctors-billing-editorial.html >

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