Names of Ontario healthcare clinics charging extra bills kept secret

Clinic and doctor names were found to have engaged in extra billing for health services, and advocates argue that this lack of transparency could affect public trust in the health care system.

Data obtained by CTV News Toronto through a freedom of information request found that 183 complaints about extra billing were filed in Ontario between January 2021 and December 30, 2022.

Of those complaints, 49 were found to have contravened the Commitment to the Future of Medicare Act (CFMA).

These contraventions included additional billing for health services that should have been covered by the Ontario Health Insurance Plan (OHIP) in the amount of just over $68,000.

But the doctors or facilities that charged patients for these services are unknown. The government removed the names of the service providers as well as the name of the facilities.

They argued that disclosure of the records could harm the competitive position of a person or organization and are therefore exempt from freedom of information laws.

CTV News Toronto is currently appealing to obtain the information in part.

When asked why the information could not be released, a spokesperson for the health minister said violations related to additional billing may be inadvertent or the result of misinterpretation by a provider or staff.

“When a CFMA investigation finds that a supplier violates the CFMA, the ministry works with the supplier to give them the opportunity to comply with the Act, so that they can continue their operations,” they said in a statement.

The ministry also argued that the information cannot be disclosed by law.

“I don’t think it serves the public interest to redact that information,” Andrew Longhurst, a health policy researcher at Simon Fraser University and research associate at the Canadian Center for Policy Alternatives, told CTV News Toronto. “I think part of a law enforcement regime means having to name and identify those who engage in illegal behavior.”

Longhurst has reviewed similar data spanning two decades and in each case the same identifying information has been omitted. She says the data is “a grossly underrepresentation” of the number of illegal overbilling that occurs in Ontario, given that the system is based solely on complaints.

“It’s not a proactive regime,” he said. “I think a lot of patients are often in a state of surprise or shock (and) don’t really realize that this is actually an illegal practice.”

Between January 2003 and April 2023, 2,884 complaints were filed for overbilling. Of those, just over 31 percent, some 916 complaints, violated the CFMA.

Data from 2021 onwards show that patients paid – and were reimbursed – for eye exams, dental extractions, stitch removal, medication injections and, in one case, a vague “health card-initiated charge.”

“I think the government needs to take this seriously, especially as more for-profit involvement is introduced,” Longhurst added.

In May, Doug Ford’s government approved legislation allow for-profit and nonprofit clinics to perform more OHIP-covered procedures, including cataract surgeries, MRIs and CT scans, minimally invasive gynecologic surgeries, and knee and hip replacements.

They insisted that patients would not have to pay for these services out of pocket.

Silvia Jones

As of January 2024, the Ministry of Health said more than 900 community surgical and diagnostic centers were operating in Ontario. This number is expected to increase in spring to allow additional MRI and CT scans, gastrointestinal endoscopies, and orthopedic surgeries to be completed.

The ministry did not say how many additional centers would be given the green light.

In January, the province also named Accreditation Canada as the inspection body responsible for ensuring quality and safety standards. A spokesperson said this month that the organization is “in the early stages of designing an evaluation program with the Ontario Ministry of Health.”

More information about the licensing process will be released closer to the program’s April 1 launch date, the spokesperson said.

As things stand, data available on the government website says 112 of the community surgical and diagnostic centers have not been assessed under current ownership or require follow-up assessment.

All other clinics have been determined to have “met the standards.”

Accreditation Canada confirmed that its program focuses on “patient safety and the delivery of quality care” and not billing issues. These concerns fall under the jurisdiction of the Ministry of Health.

What is extra billing?

The government’s decision to allow more independent clinics to perform surgeries was met with almost immediate criticism from healthcare unions, advocates and opposition leaders, who claimed it would not only squeeze hospital staff but also result in a manipulative sale of medically unnecessary products. services.

A patient is billed more when asked to pay for an OHIP-covered service, charged fees for items such as overhead costs, or pressured to purchase upgraded devices they do not need.

“The emergence of billing issues was something that I didn’t anticipate we would have to deal with from the beginning when we opened the office; it was eight years ago,” Ontario Ombudsman Craig Thompson told CTV News Toronto in an interview. .

Some of the most common complaints, Thompson said, concern improved hospital accommodations and ambulance transfers.

He acknowledged that with the addition of more community surgery and diagnostic centers, he has heard concerns about upselling, noting that some patients may sign up for something they don’t fully understand.

The Ministry of Health noted that the majority of CFMA violations have not occurred in freestanding clinics, saying that “over the last three fiscal years of data, community and surgical diagnostic centers did not have any CFMA violations, such as hospitals , doctors and other providers had multiple violations.”

However, before 2023, there were far fewer independent facilities registered with the government.

Health care

Under the new Integrated Community Health Services Centers Act, it is illegal for a service provider to offer preferential treatment in exchange for payment or ask a patient to pay for a service covered by OHIP.

However, if the Ontario Patient Advocate receives a complaint and finds a violation, all they can do is offer mediation and make recommendations.

“It’s a more informal process at first when we receive a complaint, because the best resolutions are always the ones that are timely and happen as quickly as possible,” Thompson said.

The process involves working with both parties to reach a solution, whether it be an apology, a policy change, or training.

“But at the end of the day, there is nothing in the law that allows us to force those organizations to act on what we recommend,” he said. “But we have a very good track record of working with our organizations to understand that the fairest processes are the best.”

Should the names of violators be kept secret?

Thompson says that to get the best results for the plaintiff, he doesn’t think “naming and shaming” would be productive.

“In the vast majority of situations, organizations, staff and leadership within those organizations want to do a good job of delivering health care,” he said. “So once they’re informed that there’s been a problem…then they’re more than happy to make a change to a process, make a change to a policy, train staff.”

“And at that point, we have essentially achieved what the plaintiff typically wants is for that situation not to happen to someone else in the future.”

At the same time, he said it would be “totally appropriate” to name a bad actor who consistently breaks the rules.

France Gélinas, Ontario NDP health critic, disagrees. While he noted that errors can occur and that “at the core of every doctor, there is a human being who is not perfect,” he believes the benefits of naming service providers who have violated the CFMA outweigh the risks of not doing so.

“When you know there is no oversight, when you know there is no transparency, there is much less pressure on people to do the right thing,” Gélinas said.

“This trust is something we need in our healthcare system. “When you start to lose trust in your healthcare providers, it becomes very difficult to provide quality care.”

Gélinas not only believes that service providers should be named, but would also like to see a follow-up investigation conducted to see if other patients were billed similarly.

“If you come to Ontario to make money off of sick people through loopholes, making them sign documents they can’t even read because they need cataract surgery, then we will shut you down.”

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