Ontario’s doctors have always supported a fair and transparent process regarding billing information. It is important for taxpayers to know where their hard-earned dollars are going.
Some changes proposed by the government of Ontario to the OHIP billing process include initiatives that will make the system more open and transparent. Others are fundamentally flawed and give the province sweeping powers that go far beyond what is needed to address any concerns the provincial government has.
These legislative changes ignore the fact that the vast majority of billing issues can be prevented by modernizing and providing education on the OHIP Schedule of Benefits (the Schedule), a confusing system with more than 7,000 billing codes that are written as guidelines–not a detailed document designed to be interpreted literally. Many of these codes are vague and open to interpretation. In a system this large and complex, especially one in which there is a shortage of doctors and where physicians deliver care to more than 340,000 patients every day, mistakes can be made.
For more than 10 years, the OMA has been advocating that the province update the Schedule to make it simpler and clearer. This is a foundational first step and only requires the will of the ministry to move forward.
“We understand that updating the Schedule will require a lot of time and effort. However, we see it as the only effective solution to this problem. A legislative approach such as the one the province is proposing has been tried in the past and was a dismal failure that was shown to have a negative impact on patients as well as physicians. We have repeatedly offered to sit down with the government to do the hard work needed to update the Schedule and to better educate physicians in using it to prevent mistakes,” OMA President Dr. Sohail Gandhi said.
The OMA supports increased transparency and making physician billing information public as long as proper context is provided. The OMA supports the province’s decision to modernize OHIP cards and eliminate the old red and white OHIP cards to help root out fraud in the system.
As well, the OMA also believes that no doctor should be billing inappropriately. In our experience, this happens rarely and when it does, it must be addressed. The OMA understands from the Ministry of Health it has concerns about deliberate over-billing by as few as 100 of the 31,577 practicing physicians in Ontario.
However, the legislation proposed by the provincial government adversely affects every physician in Ontario. It raises issues of fundamental fairness, puts the onus of proof on physicians, and increases red tape and administrative burdens on physicians. It also contains provisions that allow the government to introduce regulations to unilaterally amend and impose new terms on any existing agreement with physicians.
“The proposed legislation treats every doctor in Ontario as being guilty until proven innocent. Even people who receive a parking ticket have the right of appeal and more access to fair and due process than this legislation gives to physicians,” Dr. Gandhi said.
The OMA believes the province already has all the powers it needs to identify issues around inappropriate billing.
As leaders in the medical community, the OMA is actively involved in the health system transformation now underway. We will continue to advocate to correct the fundamental flaws in this legislation and ensure that Ontario has an open and transparent OHIP billing process that is fair to everyone in the system.
About the OMA
The Ontario Medical Association represents Ontario’s 43,000 plus physicians, medical students and retired physicians, advocating for and supporting doctors while strengthening the leadership role of doctors in caring for patients. Our vision is to be the trusted voice in transforming Ontario’s health-care system.
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