Friday, November 15, 2002 – Page A1

Doctors in Ontario say they are being bullied by auditors for the provincial health plan who are reviewing their previous billings and, in some cases, demanding hundreds of thousands of dollars back.

One radiologist owes $800,000, according to the Ontario Health Insurance Plan, about equal to his income over four years.

Many doctors who have been investigated by OHIP's Medical Review Committee are being treated for depression and marital problems and are cashing in RRSPs and mortgaging or selling homes to repay the money.

Some are considering leaving Canada because of the new audit laws that took effect two years ago.

"I really honestly cannot do this any more, but I love the work. So my [only choice is] that I go to the States," said Irene Vanek, a Toronto neuro-ophthalmologist who specializes in eye tumours.

The chairman of the Medical Review Committee, Barney Giblon, said the process is fair and is returning millions of tax dollars to provincial coffers.

OHIP computers red-flagged Dr. Vanek's practice because it was billing for too many complex eye exams, even though this is her specialty and doctors from across the province send patients to her.

"What is too many? I do this for a living. What am I supposed to do?" said Dr. Vanek, who has a private practice and works at Toronto Western Hospital.

She estimates she will be asked to repay half the money she has billed for nearly all the exams she has conducted during the past two years, likely more than $100,000.

Tracey Tremayne-Lloyd, a lawyer representing some of the doctors being audited, said her clients are being "bullied," and some are having emotional breakdowns.

"I've seen several bankruptcies. Some have closed their practices, have to take leave of absences or go on sick leave," Ms. Tremayne-Lloyd said.

Doctors bill OHIP about $4.5-billion a year. Audits have been conducted since the 1970s to make sure the money is paid out properly. Fraud is uncovered in fewer than 1 per cent of these audits. These cases are turned over to the Ontario Provincial Police. The Medical Review Committee's cases are labelled "errors" in billing, or "unusual billing patterns."

Two years ago, the process became more aggressive under new legislation. Doctors who decide to appeal the results of an audit must pay the costs of the audit, as well as interest on the amount deemed owing back to the time of investigation. This means that doctors who appeal could owe an extra $20,000 to $40,000.

"To our doctors it feels that they've basically put a gun to the head and said 'Pay up or we'll shoot. Pay me now without complaint or it will be double what I'm telling you if you complain,' " Ms. Tremayne-Lloyd said.

Anthony Hsu, a pediatrician working in Welland, an underserviced area attempting to recruit doctors, sees patients in his office and is on call at the local hospital every other day and every other weekend. OHIP flagged his practice because it had a high volume of patients and Dr. Hsu was performing more general checkups than the average pediatrician.

The medical review team surveyed 40 patient records and determined that while Dr. Hsu had billed for general assessments or checkups, he had not kept enough notes about those examinations.

Because of this, the team ruled he had not done the full checkup and ordered him to repay most of his billings for two years.

"In my office, when I am under pressure, I often write notes down on different pages. But patients ask many questions. I talk to them. I take the notes that are necessary," Dr. Hsu said, his voice breaking with emotion.

"It is very shameful for me and it is accusing me of stealing from the public purse. I did not."

Dr. Hsu was ordered to repay $79,943 for the visits, $20,119 in interest going back to the start of the probe four years earlier and $8,100 for the audit for a total of $108,162.

If he appeals, OHIP will deduct this amount from his billings during the next 12 months, something he felt he could not afford with a family and an office staff of two. So Dr. Hsu cashed in his RRSPs and paid the bill.

A world-renowned radiologist was ordered to repay $800,000, about 100 per cent of his income for four years, because the auditors disagreed with how he billed for some diagnostic procedures. The doctor's lawyer says that he has been left nearly penniless.

Dr. Giblon said he thinks the process is fair.