An Ontario health tribunal has ordered a Kingston, Ont. doctor to repay over $600,000 to the provincial government for improperly billing thousands of COVID-19 vaccinations at the height of the pandemic.
The dispute concerned Dr. Elaine Ma who organized drive-in vaccination clinics, administering shots in several parking lots in the Kingston region between January 2021 and January 2022.
The Ministry of Health argued Ma misused the Ontario Health Insurance Plan’s (OHIP) billing code because she hired unpaid Queen’s University medical students as volunteers who could not be considered employees. In addition, the services were not provided in Ma’s office, a violation of what the province deems to be “delegated services” that are regulated under a different fee structure.
In a ruling delivered by the Health Services Appeal and Review Board on Nov. 26, Ma was found to not be eligible to bill OHIP $600,962 plus interest.
Ma argued the Ministry was applying a strict and unreasonable interpretation of the terms “physicians office” and “employee” based on a bulletin issued 20 years ago.
Ma had spent two years fighting OHIP’s claim, insisting all OHIP billing rules were followed and argued leaving out medial students, residents and other physicians would have prevented the essential delivery of thousands of vaccines during a public health crisis.
She says it’s standard practice to bill for work medical students are involved in, and the students were given training. She also argued the province’s rigid interpretation of “physician’s office” would have required her to lease large spaces to carry out her clinics.
Ontario’s Health Insurance Act sets out which services rendered by physicians are eligible for payment as insured services under OHIP. Payment is only authorized to the physician who rendered the service personally or by a physician hired by the physician as an employee.
Physicians submit claims for payment to OHIP for insured services, which are paid on an “honour system” but can be later audited.
The general manager of OHIP found that “based on the information provided, the various individuals who administered the vaccines during the Review Period were not employed by Dr. Ma,” the ruling said.
“The Appeal Board acknowledges the efforts made and results achieved by Dr. Ma in organizing clinics to facilitate vaccinations of so many in her community. However, the Appeal Board does not have the discretion to ignore the requirements of the Act and the Regulation including the Schedule of Benefits. For the reasons set out above, the Appeal Board finds those requirements were not met.”
Ma had received support in her dispute with OHIP from Dr. Piotr Oglaza, the medical officer of health for the Kingston, Frontenac, Lennox and Addington (KFL&A) health unit, who expressed concerns the dispute could have a chilling effect.
“This could impact future planning for future pandemics, for future emergencies,” Oglaza told CTV News last month.
“It could also impact the willingness of primary health care providers and doctors to take on risk on themselves when called upon to action during a public health emergency.”