Inappropriate charges to the province's OHIP program are reportedly in the millions
As Canadian governments work to contain costs through drug price controls and tightened healthcare budgets, newly released information about Ontario indicates there’s an issue that needs a remedy.
“A freedom of information request shows the province has recovered only $1.1 million in illegitimate billings [by physicians to the Ontario Health Insurance Plan] over the past two years, while [Auditor General Bonnie Lysyk] pointed in her 2016 report to some $6 million in fees improperly paid to doctors,” reported CBC News.
According to documents obtained by CBC News, the Ontario Ministry of Health and Long-Term Care collected 48 voluntary refunds totalling $1.1 million over the past two fiscal years. The government did not disclose how many requests for refunds were made or the total dollar amount that was inappropriately billed to OHIP.
The ministry also reported six cases of possible OHIP fraud to the provincial police in 2016-17, but did not follow up to see if charges had been laid or doctors had been convicted.
CBC also found that out of over 465,000 letters the ministry sent to patients over the past two years — letters that were sent to verify that services billed to OHIP had actually been performed — fewer than 9,000 got a response.
“We certainly have a very robust mechanism and process to look at potential OHIP overbilling,” Health Minister Helena Jaczek told CBC News in an interview. “Obviously this is taxpayers' money. I know our government really cares that we make sure every dollar is used to every extent possible in appropriate ways."
The recent findings by CBC add to a weak enforcement picture initially painted by Lysyk. “The ministry lacks effective enforcement mechanisms to recover inappropriate payments from physicians,” she said in her 2016 report. “Unless a physician agrees to repay amounts voluntarily, it is very difficult to recover inappropriate payments.”
The auditor general’s report called for increased oversight of fees charged by doctors to OHIP, tougher enforcement of rules, and more effective recovery of payments — recommendations that the government said it accepts and is working on.
“Since the release of the recommendations, the ministry has increased capacity in an effort to enhance volume of ongoing payment accountability review cases,” Laura Gallant, press secretary to Jaczek, said in an email to CBC.
