The publication in 2019 of the top 100 medical billings in Ontario for the years between 2011-2018 generated a lot of attention and scrutiny of the way medical professionals bill the Ontario Health Insurance Plan (OHIP). Also in 2019, the Ontario government announced plans to revise the Health Insurance Act with respect to the way billing works, including regularly publishing the billings. This is one of many health law changes proposed under Bill 138, which was introduced in November of last year. The stated reasons behind the proposal to publish medical billings are two-fold:
The Ontario Medical Association (the OMA) has a history of objecting to similar proposals to make medical billings public. The fear is that, without proper context, the billings may be misleading to those without the appropriate insight into the process. Without an understanding of clinic overhead, payroll and other expenses, members of the public may conclude that a physician's billings are tantamount to income. Without the necessary understanding of how billings are distributed, the basic numbers do not paint an accurate picture.
With the passing of the Bill, the OMA has made it clear that it supports increased transparency with respect to OHIP billing, so long as the proper context is provided. How this will play out remains to be seen. Ontario will now become the fourth province in the country to make medical billings public information, following British Columbia, New Brunswick and Manitoba.
The government has also resolved to increase oversight into billing by adding more direct scrutiny through audits, inspections and reviews. The government has stated that the new auditing process will also have an increased education component for practitioners so that they can gain a better understanding of billing codes and processes.
Some are concerned that this new process may revert the system back to how it operated before an audit by former Supreme Court Justice Peter Cory in 2005. At the time, Justice Cory concluded that the existing system of oversight had a devastating effect on Ontario physicians, as they were faced with the prospect of defending against a presumption of guilt. After Justice Cory's findings were released, the Physician Payment Review Board (PPRB) was established, changing the way billing review was carried out in the province.
The incoming changes will look to merge the PPRB with other audit agencies and boards, which is concerning for some. There is a worry that the system will revert back to the old model, putting medical practitioners back under intense scrutiny and facing an unfair, uphill battle when it comes to defending their billing practices.
With the incoming changes, it is clear that the increased oversight of billing practices will likely lead to a growing number of audits and disciplinary action. Retaining health law counsel to advise a practitioner of their rights and obligations, and to guide and represent them through the process will be key in order to protect their interests in a stressful situation. Our lawyers have considerable experience with the investigative and audit process and can explain your obligations and responsibilities, help protect your rights, and provide effective guidance and support throughout an investigation and beyond.
At Wise Health Law, we keep abreast of evolving developments in health care law and governance, and regularly blog about recent legal decisions affecting health care industries, health associations, and health professionals. If you have questions about changes to health care governance or about health law in general, contact our health law lawyers at 416-915-4234or contact us online.
Undoubtedly, COVID-19 has affected how health professionals practice. Pharmacists across the country are not only experiencing changes in how they practice (for example, accepting emailed prescriptions, where appropriate) but the scope of their practice as well. The latter change is not permanent, although the disruptions in practice may be felt long after the COVID-19 emergency subsides.
On March 19, 2020, Health Canada issued a short-term section 56(1) exemption under the Controlled Drugs and Substances Act (CDSA) that would authorize pharmacists to prescribe, sell, or provide controlled substances in limited circumstances, or transfer prescriptions for controlled substances (the CDSA Exemption).
The past several weeks have been a challenging time for everyone. Health professionals have been bombarded with Emergency Orders and other pronouncements that can be confusing and at times seem contradictory.
With the rules and restrictions changing so rapidly, it is advisable to keep an eye on the website, social media feeds, and other communications from your respective regulatory College for your College’s interpretation and position on what you should and should not be doing during the pandemic. While the Emergency Orders and pronouncements apply to a broad spectrum of health professionals, individual Colleges can provide guidance and interpretation about how those orders and pronouncements relate to your specific profession.
But what if you’re still unsure about whether you can provide a particular service to a specific patient/client; or some other aspect of your professional obligations at this uncertain time?
Earlier this year, Wise Health Law succeeded on a motion for summary judgment in a dental malpractice case on the basis that the limitation period had expired before the Statement of Claim was issued. The (unreported) decision was delivered orally on the day of the motion.
In part, the plaintiff argued that she did not discover her claim until the Royal College of Dental Surgeons of Ontario (the “RCDSO” or “College”) rendered its decision, as she did not know if the defendant was negligent when she complained to the RCDSO, but merely had a “suspicion”.