There is a growing trend towards increased scrutiny and accountability of individual health professionals and clinics who bill or are reimbursed by insurers for services provided to patients. Health care professionals are subject to this scrutiny when it comes to their billing practices, both to government-funded payers (e.g. OHIP and Statutory Accident Benefits) and to private insurers.
Audits and/or investigations can be triggered at any time for a variety of reasons. Even where the health professional believes that he or she has resolved the issue with the patient or insurer, a broader complaint and investigation can still be triggered.
Investigations can be conducted by the health profession’s regulatory College, a private insurer, and/or the Financial Services Commission of Ontario. Any findings of irregularities or insurance fraud – even involving a few hundred dollars – can have significant implications, including suspension or loss of a license to practice, large fines, and potential criminal prosecution.
If you are being investigated or audited, it is advisable to seek assistance from an experienced health lawyer as soon as possible. The lawyers at Wise Health Law understand the various audit and investigative processes and can explain your obligations and responsibilities, help protect your rights, and provide effective guidance and support throughout an investigation and beyond. Our founder, Valerie Wise, has been practising health law for over 20 years, and is certified as a specialist in Health Law by the Law Society of Ontario.
At Wise Health Law, we provide support, guidance, and representation to health professionals who are going through an audit process, an investigation, or who have been accused of insurance fraud. We rely on more than 30 years of combined health law and litigation experience to provide clients with comprehensive assistance during what can be a stressful situation.
If you are a regulated health professional or operator of a clinic facing a complaint, audit, or investigation into your billing practices, contact the knowledgeable experts at Wise Health Law.We will help you throughout the process, ensure your rights are protected and work to manage your legal risk. We are easily accessible at our office in Oakville, Ontario. Contact us online, or at 416-915-4234 for a consultation.