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Ontario failing to recover millions in fraudulent OHIP billings by doctors

Ontario’s Ministry of Health is doing little to crack down on doctors who improperly bill OHIP, according to information obtained by CBC/Radio-Canada.

A freedom of information request shows the province has recovered only $1.1 million in illegitimate billings over the past two years, while the auditor general pointed in her 2016 report to some $6 million in fees improperly paid to doctors.

“This is a complete waste of taxpayers’ money, taxpayers’ money that was supposed to go to health,” said NDP health critic France Gélinas in an interview with CBC News.

“It is incomprehensible that when the government sees those kinds of mistakes, that they don’t recoup the money,” Gélinas said.

This suggests little has changed since 2016, when Auditor General Bonnie Lysyk criticized the health ministry for inadequately investigating fraudulent billing and for failing to follow up on physicians with a record of charging inappropriate fees to OHIP.

“The ministry lacks effective enforcement mechanisms to recover inappropriate payments from physicians,” Lysyk wrote in her 2016 report. “Unless a physician agrees to repay amounts voluntarily, it is very difficult to recover inappropriate payments.”

The freedom of information request revealed that the ministry obtained 48 voluntary refunds (totalling $1.1 million) over the past two fiscal years. But the government did not reveal how many requests for refunds were made, nor the total dollar amount of fees inappropriately billed to OHIP.

“We certainly have a very robust mechanism and process to look at potential OHIP overbilling,” said Health Minister Helena Jaczek in an interview. (CBC)

Lysyk called for increased oversight of the fees that doctors charge OHIP, tougher enforcement of the rules and more effective recovery of the illegitimate payments.

“If there is no control mechanism and monitoring, it’s easier, it’s more tempting for a doctor to exaggerate a health insurance reimbursement request,” said Gilles LeVasseur, a professor of law and management at the University of Ottawa, in an interview with Radio-Canada.

The freedom of information request shows that the

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