Doctor who deceptively bills OHIP may have registration certificate revoked: discipline committee

A medical professional who deliberately and dishonestly submits improper billings may face the penalty of revocation of certificate of registration.

In Ontario (College of Physicians and Surgeons of Ontario) v. Attallah, 2020 ONCPSD 38, a doctor was accused of collecting health card information from the family members of his patients. He would then, as alleged, improperly bill Ontario Health Insurance Plan using this information, as well as improperly bill OHIP for interviews with relatives and for services which he did not furnish. He was also accused of making false or inaccurate records such as medical charts to support these billings.

The Discipline Committee of the College of Physicians and Surgeons of Ontario found that the doctor had committed professional misconduct and disgraceful and dishonorable conduct. The committee imposed the penalties of revocation of the doctor’s certificate of registration, a reprimand and payment of costs of $124,440.

“No physician has the right to take improper advantage of the trust-based, fee-for-service system of compensation of physician services by submitting claims to OHIP for payment to which they know they are not entitled,” the committee wrote.

The committee found that the doctor’s acts constituted deliberate and dishonest conduct, for which the primary penalty considerations are the protection of the public and the maintenance of public confidence in the profession.

The committee cited Ontario (College of Physicians and Surgeons of Ontario) v. Taylor, 2016 ONCPSD 22, which also involved a case of deceptive billing, which calls for the committee to consider general deterrence when deciding upon the proper penalties. In such a situation, the penalty imposed is meant to demonstrate to the profession that such dishonest and deceitful behaviour will not be tolerated.

The doctor’s misconduct was very serious, intentional and ongoing, the committee found. Patients, family members and the Ministry of Health all raised their concerns with him, but he continued committing the alleged acts. The doctor’s actions not only breached the trust of his patients, his colleagues and the broader society but also created potential problems for his patients’ future medical care and health insurance matters, the committee said.

The committee considered the nature of the misconduct, which it found to be deliberate and ongoing, and the doctor’s involvement of his office staff to be aggravating factors. The committee also listed several possible mitigating factors, such as character references, payment, quantum of improper billings, and the absence of previous discipline matters, but accorded these factors limited significance. The committee opined that the doctor neither showed an understanding of what he had done wrong nor offered a meaningful plan for change.