The Pleasant Hill Plaza Medical Centre has a walk-in feature which attracts patients for quick procedures such as allergy shots. But the clinic habitually over-billed for these simple procedures.
Example: Instead of billing $4.70 for an allergy shot (which was the fee designated by Sask Health), the clinic called it a ‘full office visit’ and billed $18.75.
This type of fraud is called upcoding. At the clinic it was routine and systematic. During a four-year period, there were 43 separate instances of overbilling for allergy shots in one known patient. This, my own case, is reported below.
Allergy shots are a common phenomenon. Do we multiply the example by 50 patients? 100? And how many other procedures were overstated and overbilled? What are the multiplying factors?
These questions stay unresolved. The College of Physicians and Surgeons in Canada is not curbing healthcare fraud with the same vigor that Barack Obama and the FBI are shutting down the Medicare fraud gusher in the United States.
D.A. KENDEL, M.D.
Direct all correspondence
to the Registrar
Physicians and Surgeons
G.W. PEACOCK BUILDING,
211 - FOURTH AVE. SOUTH,
SASKATOON, SK S7K 1N1
Business: (306) 244-7355
Facsimile: (306) 244-0090
OUR FILE: 2-4-2 Sil G.S.
Mrs. Georgena S. Sil,
P.O. Box 1491,
Dear Mrs. Sil:
Thank you for your letter of October 22nd with enclosures.
The College of Physicians & Surgeons will undertake an investigation into the billing for the services by the physicians at the Pleasant Hill Plaza Medical Centre. In addition, we will forward this information the Medical Care Insurance Branch which is that Department in the Health Department of our Saskatchewan Government which is the paying agency for the services. They will have an interest in this information and can order reassessments within certain time periods.
When our investigation has been completed, we will be in contact with you once again.
L.M. Loewen, M.D.,
Competent caring Physicians providing quality health care.
Mrs. C. Selinger, Benefits and Inquiries
Medical Care Insurance Branch
3475 Albert Street, Regina SK S4S 6X6
Dear Mrs. Selinger:
Thank you for the statement of medical services covering the period January 1, 1989 to the present. I am writing to inquire about a pattern of charges on that statement.
Between 1989 and 1993, I attended at the Pleasant Hill Plaza Medical Centre for a single purpose, namely allergy shots. My allergist was Dr. Hardy (Saskatoon) who adequately set out the desensitization treatment plan which the Clinic followed. Note that my regular family doctor was Dr. McKee (Saskatoon), who took care of the serious physical diseases with which I have been diagnosed (Interstitial Cystitis, Osteitis Pubis, and Guillain Barre Syndrome). I attended at the Pleasant Hill Plaza Medical Centre only for my allergy shots, and did so for several reasons: the shots were frequent, I lived just around the corner from the Clinic, and they offer the convenience of ‘walk-in’ appointments.
My first allergy shot at the Clinic was on June 22, 1989; this is listed on the statement as a ‘procedure’ and the charge was $4.70. This seems appropriate. After that, however – from July 28, 1989 to January 27, 1993 – the billing does not seem to reflect the reality.
During that time, the Pleasant Hill Plaza Medical Centre billed for ‘doctor visits’ in forty-three separate instances when in fact only a quick and simple procedure – an allergy shot – was done. I have enclosed a copy of the statement, with these 43 instances highlighted. Note that the doctors' names vary, as I was treated by the specific doctor assigned walk-in duties that day. Enclosed for your reference also is a copy of my medical records from Pleasant Hill Plaza Medical Centre, which clearly define my medical treatment as being simple allergy shots intended to follow the treatment schedule laid out by my allergist Dr. Hardy.
Note that I liked the doctors at the Clinic, and felt their care was adequate. I stopped attending only when I moved my residence from the west to the east side of the city. I now take my allergy shots at Acadia Medical Clinic, it being the closest walk-in clinic to my new residence. I note that Acadia consistently bills only for a procedure.
Since I am unfamiliar with the billing regulations of SASK HEALTH, I thus present this material to your department for review, to decide whether there has been, or has not been, excessive or inappropriate billing by the Pleasant Hill Plaza Medical Centre. This Clinic billed for forty-three ‘doctor visits’ at a total charge of $800.60. Those same allergy shots, if recorded as ‘procedures,’ would have cost about $202. The difference is $598. Multiply that figure by the number of patients attending the Clinic in similar circumstances. Since allergy shots are such a common phenomenon, the grand total may be quite considerable.
Thank you for your prompt attention to this matter.
Georgena S. Sil
Tuum Est - It Is Up To You
It is no use saying: We are doing our best. You have got to succeed in doing what is necessary.
In Canada, citizens may apply for a statement of insured services paid by Medicare on behalf of the individual. The right to this information is guaranteed under HIPA legislation as well as the Freedom of Information Act.
If your billing statement shows fraud, or any kind of unusual pattern, report it promptly to the Ministry of Health in your province. You should also notify the College of Physicians and Surgeons.
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