An Ontario well being tribunal has ordered a Kingston, Ont. physician to repay over $600,000 to the provincial authorities for improperly billing hundreds of COVID-19 vaccinations on the peak of the pandemic.
The dispute involved Dr. Elaine Ma who organized drive-in vaccination clinics, administering photographs in a number of parking tons within the Kingston area between January 2021 and January 2022.
The Ministry of Well being argued Ma misused the Ontario Well being Insurance coverage Plan’s (OHIP) billing code as a result of she employed unpaid Queen’s College medical college students as volunteers who couldn’t be thought of staff. As well as, the companies weren’t offered in Ma’s workplace, a violation of what the province deems to be “delegated companies” which might be regulated beneath a distinct charge construction.
In a ruling delivered by the Well being Providers Attraction and Evaluation Board on Nov. 26, Ma was discovered to not be eligible to invoice OHIP $600,962 plus curiosity.
Ma argued the Ministry was making use of a strict and unreasonable interpretation of the phrases “physicians workplace” and “worker” primarily based on a bulletin issued 20 years in the past.
Ma had spent two years combating OHIP’s declare, insisting all OHIP billing guidelines have been adopted and argued leaving out medial college students, residents and different physicians would have prevented the important supply of hundreds of vaccines throughout a public well being disaster.
She says it is normal apply to invoice for work medical college students are concerned in, and the scholars got coaching. She additionally argued the province’s inflexible interpretation of “physician’s office” would have required her to lease giant areas to hold out her clinics.
Ontario’s Well being Insurance coverage Act units out which companies rendered by physicians are eligible for fee as insured companies beneath OHIP. Cost is simply licensed to the doctor who rendered the service personally or by a doctor employed by the doctor as an worker.
Physicians submit claims for fee to OHIP for insured companies, that are paid on an “honour system” however will be later audited.
The overall supervisor of OHIP discovered that “primarily based on the knowledge offered, the varied people who administered the vaccines in the course of the Evaluation Interval weren’t employed by Dr. Ma,” the ruling mentioned.
“The Attraction Board acknowledges the efforts made and outcomes achieved by Dr. Ma in organizing clinics to facilitate vaccinations of so many in her neighborhood. Nonetheless, the Attraction Board doesn’t have the discretion to disregard the necessities of the Act and the Regulation together with the Schedule of Advantages. For the explanations set out above, the Attraction Board finds these necessities weren’t met.”
Dr. Elaine Ma administrate vaccine throughout a drive via COVID-19 vaccine clinic at St. Lawrence School in Kingston, Ontario, on Sunday January 2, 2022. (Lars Hagberg/THE CANADIAN PRESS)
Ma had acquired help in her dispute with OHIP from Dr. Piotr Oglaza, the medical officer of well being for the Kingston, Frontenac, Lennox and Addington (KFL&A) public well being unit, who expressed issues the dispute might have a chilling impact.
“This might impression future planning for future pandemics, for future emergencies,” Oglaza instructed Ontario Chronicle final month.
“It might additionally impression the willingness of main well being care suppliers and docs to tackle danger on themselves when known as upon to motion throughout a public well being emergency.”
