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The Ontario Medical Association is looking for an apology from the province, after it says hundreds of doctors recently received letters stating they were working too many days or seeing too many patients.
The association is concerned the letters may scare some doctors into reducing their hours, creating delays in patient care in a time of crisis when Ontarians need more family doctors and medical services, said Dr. Rebecca Hicks, president of the Ontario Medical Association.
“The hours that we’re working to see patients, the extra hours we’re working on evenings and weekends, that’s not fraud. That’s patient care. That’s our job,” she said. “We should be supporting physicians who are doing that, not sending them warnings of investigations. ”
She said “at least hundreds” of letters on high-volume billings were sent out across the province, but did not have an exact number.
CBC News was able to see one of the letters sent out by the health ministry’s payment accountability and fraud control unit. Dated Oct. 27, it stated physician billing information is monitored “to support the integrity, accountability, and sustainability of the Ontario Health Insurance Plan (OHIP).”
The letter flagged “anomalous behaviour” that was higher compared to other doctors with similar practice profiles. Hicks said doctors received letters either noting they had worked a high number of days in a year or had seen too many patients in a single day.
While the letter stated billing patterns may have legitimate reasons behind them, it also said persistent unusual billing may undergo further review by the ministry.
Letters not assumption of inappropriate billing: ministry
The letters are meant to be educational and not an assumption that billing was “inappropriate,” health ministry spokesperson Lily Barnes told CBC News in an emailed statement.
She said the province is in regular communication with doctors over OHIP billing practices and the letters were intended to flag higher-than-expected billing based on claims data. Doctors could be flagged for abnormal billing if they worked more than 15 hours or saw more than 100 unique patients in a day.
“The ministry recognizes that physicians have diverse practice models, specialties, patient populations, and service delivery arrangements that may appropriately result in higher billing volumes,” she said.
The ministry did not directly respond to CBC News’s questions on how many letters were sent out to family and specialist doctors, how high-volume billing was determined and what level of billing would warrant an investigation.
Ontario’s auditor general has found the system used by the province’s health ministry has a limited ability to flag high-risk billings from doctors. An analysis of claims over the last three years found that in each year at least 59 doctors billed for more than 24 hours of service in a day.
Last year, Ontario’s auditor general Shelley Spence released a report noting the province was not properly overseeing doctors’ billings, including cases where more than 24 hours in a day were billed.
Spence flagged that the system doctors use to bill OHIP was not able to automatically flag high-risk billings.
Most physicians well-intentioned, few bad apples: doctor
Dr. Adam Stewart said it was unfair of the province to send “a threatening, intimidating letter,” when doctors are overwhelmed and working hard to support patients during a shortage of family physicians.
“Most doctors are well-intentioned, good-natured and highly qualified … especially given the circumstances of a crumbling health-care system,” he said, adding there are bound to be a few “bad apples” taking advantage of the system.
Stewart, who works at a family health organization in Madoc, Ont., says he has around 1,700 patients under his practice and on average sees people for over 30 hours per week with an additional 10 to 20 hours of paperwork. He says a colleague with fewer hours and fewer patients, around 1,150, also received the letter.
Hicks said there is no cap on doctors for how many days they can work or patients they can see in a day. She said the province’s new family medicine remuneration model allows up to 14 hours a day through hourly billing.
Patient care can also vary between areas, with rural doctors possibly working longer hours due to the need in the community, Hicks said.
“There’s so much demand right now,” she said. “If they’re being asked to cut back on that, well, where are [patients] supposed to go?”
Hicks said the OMA will be speaking with the government for more information on the letters and how the ministry decided who received them.
