A Kingston, Ont. physician who has been ordered to repay greater than $600,000 to the provincial authorities for improperly billing hundreds of COVID-19 vaccinations says she’s not stunned by the decision however is disillusioned by it.
The dispute involved Dr. Elaine Ma who organized drive-in vaccination clinics, administering pictures in a number of parking heaps 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-about staff. As well as, the providers weren’t supplied in Ma’s workplace, a violation of what the province deems to be “delegated providers” which can be regulated beneath a distinct price 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.
“It is actually nonetheless simply disbelief that we have fully forgotten about COVID,” she informed Ontario Chronicle Ottawa on Monday. “We have fully forgotten what we have been requested to do. We have fully forgotten the truth that we have been requested to do it in new and other ways, and shortly, and as quick as attainable. We have fully forgotten that the Ministry of Well being supplied a per-shot vaccine code, and that was what was billed. It wasn’t something over that. It was the sum of money that they allotted for these pictures to be given.”
She added that she doesn’t have the cash she is being requested to pay again.
“It wasn’t an sum of money that I acquired. Sure, I acquired it, however a whole lot of it then circled and paid to run these clinics. So, do I’ve this sum of money sitting round, simply ready to get again to OHIP? No. Additional, that may imply that I’ve truly paid to vaccinate 36,400 individuals in our neighborhood, out of pocket, at my expense,” she mentioned.
Ma argued the Ministry was making use of a strict and unreasonable interpretation of the phrases “physicians workplace” and “worker” based mostly 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 massive areas to hold out her clinics.
Ontario’s Well being Insurance coverage Act units out which providers rendered by physicians are eligible for fee as insured providers beneath OHIP. Cost is just 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 providers, that are paid on an “honour system” however may be later audited.
The final supervisor of OHIP discovered that “based mostly on the knowledge supplied, the assorted people who administered the vaccines throughout 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.”
Ma mentioned Monday she doesn’t know if she’ll attraction the decision as a result of it could be time away from household and pals.
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 assist 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 considerations the dispute may have a chilling impact.
“This might influence future planning for future pandemics, for future emergencies,” Oglaza informed Ontario Chronicle final month.
“It may additionally influence the willingness of major well being care suppliers and docs to tackle danger on themselves when known as upon to motion throughout a public well being emergency.”
–With information from Ontario Chronicle Ottawa’s Kimberley Johnson
