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Dr. Elaine Ma is a Kingston family physician. (Supplied photo) Supplied photo
Ontario’s health insurance body is looking to appeal a recent decision from the Divisional Court that partially sided with Kingston doctor Dr. Elaine Ma regarding over $600,000 in COVID-19 vaccination clinic billings.
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In a motion submitted on Tuesday, OHIP’s general manager requested permission from the Ontario Court of Appeal to contest the Divisional Court’s decision. They argued it misinterpreted an important part of the Health Insurance Act (“the Act”) and raised significant public issues regarding OHIP’s administration. Specifically, OHIP pointed out section 17.5 of the act allows for payment claims even if billing conditions aren’t fully met when “extenuating circumstances” are present. The court will decide on this motion in writing at a later date.
Ma set up 48 distinct COVID-19 vaccination clinics in Kingston between July 2021 and January 2022. During these clinics, she worked alongside other doctors and medical students to provide vaccinations. However, OHIP later decided she couldn’t bill for those services and instructed her to repay $600,962.
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<PAccording to Ma OHIP didn’t fully recognize how much time effort and costs were involved with running those mass vaccination clinics especially considering what needed done before and after each event She mentioned that no one at OHIP ever asked her for a detailed breakdown of expenses Yet there seemed to be an assumption made that those clinics were making money something she disputed explaining that some actually lost money She covered all costs herself even paying fellow physicians who helped out She also stated she completed necessary prep work ahead of time and entered required information into Ontario’s system after each clinic
Ma contested OHIP’s ruling through the Health Services Appeal Review Board (HSARB) which is a tribunal created by the Ministry of Health Long-Term Care handling appeals under various healthcare laws In November 2024 HSARB upheld OHIP’s decision
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Afterwards Ma sought judicial review concerning HSARB’s ruling On December 16th Divisional Court supported HSARB’s findings about billing issues but disagreed with their take on section 17.5 The court determined this provision could apply both prior too payments being made as well as afterward It ruled it unreasonable for HSARBto conclude that pandemic conditions didn’t count as extenuating circumstances
Ma appeared before Division Court December second The outcome issued by Justice J Matheson revealed although she technically didn’t comply with certain billing rules it was unfair not acknowledge extraordinary circumstances during COVID -19 crisis Governments urged doctors quickly vaccinate large groups so failing recognize those pressures wasn’t reasonable. This has not loaded yet but your article continues below < pp <The Divisional Courts ruling outlined by Justices J Matheson M Varpio S O’Brien thoroughly reviewed HSARBs original assessment concluding while Ma may still owe some money she shouldn’t have pay back full $600000 amount first demanded. The court referred case back board for re-evaluation based written input both sides<In its request appeal OHIPs argues Divisional Courts understanding Section17.5incorrect legally inconsistent structure Health Insurance Act.OHIPs stance insists wording Section17.5 only considers discretionary payment options before funds distributed emphasizing different parts act directly address recovering reimbursements already processed pointed out broader interpretation leads complexity uncertainty surrounding physician payment conflicts.<< This has not loaded yet but your article continues below< p
< p General Manager OHIPs further claimed Divisional Court wronglyextended H SARBs powers assertingit only evaluates ifbillingrequirementsmetandcannotmake discretionary decisionsaccording Section17.5. The case raises relevant public concerns about how physician billing disagreements handled examined because effects administration O HIP.
If granted permission appealwould move forward full hearing Ontario Court Appeal province highest court Chief Justice Ontario Associate Chief Justice Ontario30other judges preside over appeals Most cases heardby three judges though some require five. Ma’s legal team wasn’tsurprised OHIPsdecision seekappeal due positions taken thus far. OHIPs holdshas thirty daysfilefull motion recordwith supporting argument then M’as attorneys have twenty-five days respond since leave appeal relies solelyon written documents Kingstonist reachedout OH IP Ontario Ministry Health comment however received no reply Michelle Dorey Forestelliswith Kingstonist LJIfunded federal government
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