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To All Ontario Family Physicians - July 16, 2002.
THE LIVING DEAD – VICTIMS OF MRC
AUDITS
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here to view actual fax broadcast version (requires
 )
We believe that the majority of you are aware of the MRC (Medical
Review Committee) process. But, do you know anyone who has been
audited and penalized? There are approximately 100 physicians each year.
We know several family doctors who have been victimized and
left demoralized, disgraced, and downright depressed – alive, but with
their souls siphoned out. Here are the facts about the MRC process.
Some MRC Basics:
The powers of the CPSO
MRC were legislated by the Health Insurance Act. As stated
in the MOHLTC
Bulletin 4383 (pdf link) with the "wonders" of I.T., they
now quickly identify physicians who may not be billing "appropriately".
The top 5 monitored codes are mostly ours: 1) A007A, 2) A003A, 3) A004A,
4) K007A and 5) K013A. If you are suspected for outright fraud,
then the OPP’s Anti-Rackets Squad investigates you. You may only
receive a letter from the general manager of OHIP inquiring about
a perceived billing irregularity. Do not be fooled by this
seemingly harmless correspondence – it can lead to an automatic repayment
or a referral to the MRC. The other option the general manager
has is to directly refer you to the Medical Review Committee.
The irony is that this can occur even while providing exceptional
care to your patients.
What Happens to MRC Audit Victims
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You are
presumed guilty until proven otherwise. |
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You may
be invited to attend an interview. |
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You are
immediately forced to pay the money back over
a one-year period. |
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Interest
is charged retroactively
on the amount in question. |
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If your
current billings are not adequate to pay the penalty, then
your assets can be seized. |
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The recent
"expedited MRC process" is not any better.
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The CMPA
supports you to a limited degree only. |
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The COFP
has learned that the MRC can return to review a different time
period for the same infraction. Lightening can strike twice!
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Can You Prevent Being Audited with 100% Certainty?
We don’t think so, but do consider:
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Adequately
document your work. It
is the only proof that you provided and performed the services.
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Ensure
that you understand and appreciate the provisions of the Schedule
of Benefits. |
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Billing
large numbers of A003As and/or no or few A001As can trigger
the OHIP computer watchdogs. (The A0001A fee should be
abolished – more on this in a future bulletin) |
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Ask for
a billing profile from OHIP to see if you are reasonably
close to the average. (About $75) |
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Avoid
billing K007A and bill K005A (Primary Mental Health) Always
record the start and end times. |
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Bill K013A
only if pre-booked and again record the start
and end times. |
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Consider
additional newly available insurance for when the CMPA deserts
you (contact us for details). |
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Again,
do NOT ignore any letter from OHIP
pointing out unusual billing patterns. Call the CMPA, your lawyer,
or other legal firm familiar with the MRC immediately.
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BUT, please
do not under bill for fear of being audited.
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"Bill as if you hand your patient the bill.
Document as if you’re going to be sued"
It is well past time to correct this
unfair process. The COFP will make our views known at the MRC.
We will also work to reword the Schedule
of Benefits preamble to eliminate any billing "traps".
Doug Mark MD, President Allan Studniberg MD CCFP, Interim
Vice President,
Executive Committee, Coalition of Family Physicians of Ontario
OUR VICE PRESIDENT STEPS DOWN, BUT FOR GOOD REASON
After an exemplary year of leadership and service, Dr. Tom
Weinberger is stepping down from his post as vice president for
1 year. As many of you know, he has attained the position of Chair
of the OMA GPFP Section Executive. This requires a considerable
time commitment and he will not be able to devote the needed time as COFP
vice president. We wish him well and support his efforts within the OMA.
In the meantime, we are proud to inform you that our interim Vice
President is from our executive, Dr. Allan Studniberg of Toronto.
We have been collecting nominations from our members and will be holding
an election in September.
PRIMARY CARE REFORM and FAMILY HEALTH NETWORKS
As you likely know, only 1 or 2 FHN groups have been formed
so far. We’re not surprised as our petition/survey in January
revealed that only 2% of family doctors approve of the FHN
contracts. We believe that Primary Care does not need reform,
but it can be enhanced by providing adequate funding, affordable/practical
I.T., benefits, ancillary health providers, province-wide integrated "telehealth",
more doctors, less bureaucracy, more public health promotion,
and more health care resources.
Our website is getting a complete facelift with the help
of our executive member from Sudbury Dr. Dennis Reich and his company
Canadianphysician.ca.
Not only do we now have online membership payments, but also our
long awaited members-only section and chat room will be available
soon.
UPCOMING TOLL-FREE PHONE AND FAX NUMBERS
For all of you out of the Toronto local calling area, our toll free numbers
will be:
1-866-495-4346 Voice and 1-866-495-4349 Fax (Effective July 29, 2002)
OUR INSURANCE SURVEY RESPONSE HAS BEEN OUTSTANDING
Many hundreds of you have sent in your survey to assist
in assessing the insurance needs of Ontario’s family physicians. So why
are we doing this? It’s not to replace your current insurance or investment
strategy, but rather to provide you with more "direct-to-you
rewards of membership" from the COFP. Stay tuned!
WHAT’S NEXT?
We are building up for a probable provincial election in 2003.
Soon after that will be negotiations with the MOHLTC for a new Master
Agreement in 2004. We plan on being there for all of you.
Will you be with us?
COFP MEMBERSHIP FEEDBACK - Click
Here to send us an email
Please use this section to send us any comments, criticisms,
questions, ideas, or email/address updates. Although we cannot respond
to every fax or email, be assured that we do read all of them!
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