Two years ago, the government of
Ontario stopped auditing physician billings. Ontario
docs had been miserable under the old system for years,
but it took the suicide of Dr Anthony Hsu, a Welland
pediatrician who was ordered to repay over $100,000
in contested billings, to remove the reviled Medical
Review Committee from its watchtower.
In the interim, an independent
commission was set up under Justice Peter Cory to examine
the audit system and propose changes. On December 12,
legislation was tabled that will put many of Justice
Cory's recommendations into practice (see Hear ye,
hear ye! The MRC's dead on page 28) and introduce
a fairer and more humane audit system for the province.
One of the key elements is education
for physicians about how to submit claims. This acknowledges
that the major reason for billing errors is honest error,
not premeditated fraud. OHIP billing hasn't made it
onto the curriculum of too many faculties of medicine
and the learn-as-you-go method clearly had its shortcomings.
The effort will not be wasted, and the onus is on OHIP
to make it happen.
As well, a Joint Committee on the
Schedule of Benefits provides a venue for review of
the Schedule itself and its interpretation. This could
allow problematic areas to be examined before they raise
a red flag on half of the province's docs.
Most important is a return to the
presumption of innocence and abolition of some of the
old system's more draconian repayment practices. Only
cases that cannot be resolved through education and
the Payment Review Program would proceed to formal hearings.
Much as citizens want to know that
doctors are billing fairly, they don't want them preoccupied
by excessive paperwork and endless justifications of
what they do. The system should be tailored and adaptable
to an evolving set of needs and practices. Ontario's
bill is on the right track. — Susan Usher, Health
Policy Editor
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