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The Banknote Mill of Drs. Nayar, Khan, Dangor & Datta

Evidence:  Statement of Practitioner Services

Did the MCIB Fulfill its Ruling for the Nayar Fraud?

2007 – MCIB Ruling
Source: Perry Behl Letter
2016 – Evaluation a Decade Later
Source: Nayar Fraud: Statement Update 2016(sidebar, right)

Policy 1

The inappropriate billings ceased effective Jan/07.

Actualized

The Nayar fraud did cease in January 2007.

Policy 2

While there has been a recovery of funds … our systems do not allow for removal of claims that have been paid to physicians.

Actualized

All the illicit billings remain on the Statement. The MCIB was open about its surreal policy in 2007 which should have matured in a decade. The Statement, after all, has more than a financial purpose.

Our sidebar (right) offers statistics:  A standard Statement page has 37 entries meant to portray the real medical history of a patient. But during the four years of the Nayar era, the number of phantom appointments on each page ranges from 17 to 29 an error rate of 45% to 78%.

Policy 3

We have noted in your situation that some claims were inappropriate.

Evaporated

On the updated Statement of 2016, the illicit billings are not marked or identified in any way. There is not even a general note to warn readers to disregard claims referencing Drs. Nayar, Khan, Dangor & Datta.

Ruling from MCIB, Saskatchewan Health

·  Drs. Nayar, Khan, Dangor, and Datta Repay Funds Obtained via Fraud
·  Billing Record Still Interleaves 134 Fake Appointments with Legit Ones

November 15, 2007

Ms. Georgena Sil
P.O. Box 1491
SASKATOON  SK S7K 3P7

Dear Ms. Sil:

Thank you for your letters dated October 18, 2007, following up on concerns you raised in 2006 relating to specific physician billings that appear on your Statement of Physician Services, and October 21, 2007, requesting a copy of your Statement of Physician Services.

As a result of the Department’s review of your concerns, the billings identified as inappropriate ceased effective January 15, 2007. The Statement of Physician Services provided to you on March 8, 2007 and the statement attached, show that the last inappropriate billing occurred in January 2007. Saskatchewan Health has successfully worked with the physicians involved on the recovery of inappropriately paid amounts.

While there has been a recovery of funds, your Statement of Physician Services will continue to reflect all payments made to the physicians. Our systems do not allow for the removal of claims that have been paid to physicians; however, we have noted in your situation that some claims were determined to be inappropriate.

Thank you again and I trust that your concerns relating to the physician billings have been addressed.

Yours truly,

Perry Behl
Director
Professional Review & Quality Management

Attachment

Letter #2 to Saskatchewan Health / Medical Care Insurance Branch

·  Updated Billing Statement Shows:  Initial 95 Fake Claims Not Yet Prosecuted
·  Instead, Scam Barrels Ahead:  Dr. Nayar Claims 39 More Fake Appointments

Dr. Arun Nayar:  Cover Letter Attached to His Medical Chart

·  Nayar Admits that Only 2 Appointments Actually Took Place

Letter from College of Physicians and Surgeons of Saskatchewan

·  CPSS Assists in Obtaining Medical Chart from Dr. Nayar

CPSS Seal

REGISTRAR:
D.A. KENDEL, M.D.

College of
Physicians and Surgeons
of Saskatchewan

G.W. PEACOCK BUILDING,
211 - FOURTH AVE. SOUTH,
SASKATOON, SK  S7K 1N1

Business: (306) 244-7355
Fax: General (306) 244-0090
Fax: Dr. Kendel (306) 244-2600
email: cpss@quadrant.net
www.quadrant.net/cpss

OUR FILE:

February 27th, 2007

Ms. Georgena Sil
Box 1491
Saskatoon, SK S7K 3P7

Dear Ms. Georgena Sil,

The College of Physicians and Surgeons acknowledges the copy of your letter requesting medical records from Dr. A. Nayar.

The physician's office may require a fee for providing the medical record requested, according to the Saskatchewan Medical Association Relative Value Guide and Fee Schedule for Uninsured Services.

Sincerely,

Virginia Marsh
Regulatory Services Coordinator
College of Physicians & Surgeons of Saskatchewan

cc:  Dr. A. Nayar

VGM/vgm

Competent caring Physicians providing quality health care.

Chart Request Addressed to Dr. Nayar at Medical Arts Building

·  Clinical Notes:  Concrete Proof of Patient’s Appointment Schedule

Letter from Saskatchewan Health, Medical Care Insurance Branch

·  College Forwarded Formal Complaint to MCIB / Investigation Begun

May 26, 2006

Ms. Georgena Sil
214 Whitecap Crescent
SASKATOON SK S7M 5C7

Dear Ms Sil:

The College of Physicians and Surgeons of Saskatchewan has forwarded a copy of your complaint filed with them detailing our concerns regarding billing of services by Doctors Nayar, Khan, and Dangor.

Please be advised that the Medical Services Branch is in the process of investigating your complaint and allegations with the physicians in question. In the interim we have noted your file that the services in question are under investigation.

You may be interested in knowing the particular service code billed on your behalf is described as a routine visit to a nursing home. The actual payment schedule description of this particular item is a visit on a regular basis to a patient to provide an examination, assessment or evaluation of the patient's condition; advice as necessary to the patient and/or the nursing staff concerning management of the patient.

Thank you for your concern with the billing information you received from the Medical Services Plan.

Sincerely,

Brad Havervold
Executive Director

cc:Karen Shaw, Deputy Registrar, CoPSS
Doug Trew, Director, MSB

Letter from College of Physicians and Surgeons of Saskatchewan

·  Response to Formal Complaint:  Forward Billing Info to MCIB

CPSS Seal

REGISTRAR:
D.A. KENDEL, M.D.

College of
Physicians and Surgeons
of Saskatchewan

G.W. PEACOCK BUILDING,
211 - FOURTH AVE. SOUTH,
SASKATOON, SK  S7K 1N1

Business: (306) 244-7355
Fax: General (306) 244-0090
Fax: Dr. Kendel (306) 244-2600
email: cpss@quadrant.net
www.quadrant.net/cpss

OUR FILE:

May 5, 2006

Ms. Georgena Sil
P.O. Box 1491
SASKATOON, SK  S7K 3P7

Dear Ms. Sil:

As Medical Manager of the Complaints Resolution Advisory Committee, I have reviewed the complaint you have lodged against a number of physicians with respect to allegations of inappropriate billing.

The Medical Services Branch of Saskatchewan Health is the paying agency for services. They will have an interest in this information and can order reassessments within certain time periods if necessary. The information has been forwarded to them for their review with the exception of the consult letter from Dr. Taranger, operative report concerning your cystoscopy, and the letter from Dr. Jonat. These documents have been removed to protect your privacy. If you feel they are important documents that the Medical Services Branch should have in the review of your complaint, please provide them copies.

Our complaints process will not be reviewing this matter at this time. The College has requested to be informed at the conclusion of the Medical Services Branch's review, and if appropriate, will review the matter at that time.

Sincerely,

Karen Shaw, M.D.
Medical Manager
Complaints Investigation and Resolution Process

KS/mcd

Competent caring Physicians providing quality health care.

Formal Complaint to College of Physicians and Surgeons

·  Excerpt Below Conveys Substance of Complaint  /  Go to: Full Complaint (PDF)

GEORGENA SIL MARCH 22, 2006

7. Provide a brief and clear description of the complaint(s) you have about the physician(s) named in the complaint. Include examples where appropriate (e.g. if you are alleging rude behavior, provide an example).  (If a letter of complaint has been received by the College, it will be attached to this form. You may add additional information as necessary.)

Recently I applied to Sask Health for a billing statement, simply to update my files at home. The statement was printed March 2/06.  When it arrived I was stunned to see that four GPs had committed financial fraud on a massive scale.

Altogether, these GPs billed $1,956 for a series of 95 appointments which did not exist. Refer to detailed analysis attached. To summarize the excess fees claimed by each GP:

Dr. Nayar 21   visits 450.00   excess
Dr. Khan 44   visits 882.00   excess
Dr. Dangor 28   visits 582.00   excess
Dr. Datta 2   visits 42.00   excess

As house physicians to McCoshen Care Home, these GPs make rounds of their patient-group every two weeks, and attend to emergencies when called. But this involves only about 50% of the Care Home residents.

The remaining residents choose their own GP outside of (and independent of) the Care Home. I am in this category. When I moved into the Care Home in August/03, my choice of GP was in transition. Dr. Nayar and Dr. Khan assisted me briefly. Then during 2004-05 I consulted only GP Dr. Balakrishna and later Dr. Straza.

The false claims from Drs. Nayar, Khan, Dangor and Datta began in the autumn of 2003 and continued steadily until Feb/06, which is just before the billing statement was printed. This fraud is active and is still ongoing.

The dollar amount of the fraud concerns me. But equally, I am concerned about the assault to my good reputation. The 95 fictitious appointments make me appear absurd, as if I made a hobby of visiting a new GP each week.

8. What is your expectation from the investigation of this complaint?

(1) To require Drs. Nayar, Khan, Dangor, and Datta to reimburse $1,956 to Sask Health.  (2) To prepare a streamlined billing statement for me with the 95 false claims removed.

  Additional Comments

Statute of Limitations
Most citizens are not aware they can obtain a Statement of the fees billed against their health number. Those who are aware, often obtain it too late. This was my experience in 1995-96 at Pleasant Hill Plaza Medical Centre (documents attached). There is a two-year limit period for financial reassessment. Within that timeframe, Saskatchewan citizens should automatically receive their personal billing data for review.

Letter #1 to Saskatchewan Health / Medical Care Insurance Branch

·  Drs. Nayar, Khan, Dangor & Datta Bill for 95 Non-Existent Appointments

Initial Report to the Saskatoon Police Department:  A Citizen’s Duty

·  Dr. Nayar Fraud / At this Point, the Phantom Appointments = 95
·  Report Forwarded to the Saskatoon District Prosecution Office

Georgena S. Sil
Saskatoon, Canada
Physicist & Technical Writer
Alumnus: University of British Columbia
TuumEstContact@protonmail.com

Copyright © 2008-2018 Georgena Sil. All Rights Reserved.