Do the math: Doctor billed for almost 51,000 tests in 4 years but had only 4,800 corresponding test supplies

A Toronto family physician has been found guilty of billing for tens of thousands of tests and procedures he never did, including purported routine urine drug screening for patients as young as nine years old. Dr. Ayokunle Fagbemigun is also guilty of charging for patient referrals to a cardiac clinic and keeping inaccurate records in multiple patients’ charts, according to the decision document issued by the Ontario Physicians and Surgeons Discipline Tribunal. Dr. Fagbemigun, who denies all the allegations, is now awaiting a penalty hearing. According to the tribunal, Dr. Fagbemigun billed for eight types of services he didn’t perform: urine pregnancy tests, urinalysis, rapid strep test, urine drug screen, ear syringing and curetting, simple spirometry, flow volume loop and nerve conduction study. Read: Doc facing 7-year-old $146K fraudulent billing case gets suspension and $31K penalty on separate issue OHIP records showed Dr. Fagbemigun was the top biller from 2016 to 2018 for ear curetting, claiming more than double the second highest biller in 2018 and almost triple in 2017. During this period he was also in the top 0.5% for strep test billing and in the top 25% for drug screening. While high-volume billing for tests is not of itself a misconduct, in Dr. Fagbemigun’s case the patient files reviewed by a college-appointed medical expert revealed majority of the tests purportedly conducted were not clinically indicated. For example, one patient whose records showed no indication she was sexually active had generated claims for eight pregnancy tests over 13 months. According to the decision document, the expert concluded that of the 39 urine drug screens she reviewed, only eight had any indication for conducting the test. Of the 66 nerve conduction studies she looked at, only two were appropriate in her opinion. The expert also noted that Dr. Fagbenigun routinely conducted digital rectal exams of men between 18 and 32 without any indication of rectal or prostate issues. “This is, in (the expert’s) opinion, inappropriate,” the tribunal wrote. “We accept that opinion.” Read: Expense fraud trial of former hospital chief executive underway in Halifax court An extensive analysis of Dr. Fagbemigun’s OHIP billing for 2017 revealed that in a single year he claimed 84 patients each had their ear syringed more than 10 times, 144 patients each had five urinalysis tests, 23 patients each had more than five pregnancy tests and 64 patients each had at least two pulmonary function spirometry tests. Of the 46,865 tests Dr. Fagbemigun billed for between August 2014 to September 2018–a total that does include nerve conduction studies–more than 42,000 did not have corresponding supplies, according to the decision document. A review of the clinic’s purchasing records showed Dr. Fagbemigun had ordered supplies enough for just 4,550 of the tests in question. Similarly, Dr. Fagbemigun’s billing between 2016 and 2018 for nerve conduction studies showed 3,894 claims and a purchase of only 200 biosensors, on top of 40 biosensor samples he received from the distributor. “Even if he used each biosensor on two patients, the biosensors he bought from the Canadian distributor, in addition to the samples received, allowed for 480 tests,” wrote the tribunal in the decision document. Read: Sask. doc loses licence for falsifying immigrant medical tests Dr. Fagbemin testfied that he had bought some biosensors from another physician–whom he could not identify–and that he paid $15 for each sensor to a total of around $4,000. “That would be approximately 266 more sensors, far from enough to account for the nearly 4,000 tests,” wrote the tribunal. The tribunal also found Dr. Fagbemigun had received referral fees from a cardiac test provider that used his office space. College investigators found booking sheets for the cardiac test provider that listed patients’ names, appointment times, total number of patients seen, no-shows and total number who refused services. In two separate interviews, Dr. Fagbemigun told the college he originally charged a flat rate for the room rental but later switched to a fee of $20 for every patient he referred and was seen. He told the college the payment was sometimes made in cash sometimes by cheque. After being told by a third party that he should not be charging by the patient, he switched back to charging a flat rate. “Dr. Fagbemigun billed for services he did not provide and took referral fees for referrals to a cardiac care provider,” wrote the tribunal. “He put inaccurate information in patient charts and sent his patients for unnecessary tests that could cause them anxiety, time and inconvenience. He did this for his own financial gain, at the cost of his patients’ care and the public health care system. He intentionally received many thousands of dollars to which he was not entitled.” Read: STICKY SITUATION: Psychiatrist slammed for giving patient tape and instructions on genital tucking

Do the math: Doctor billed for almost 51,000 tests in 4 years but had only 4,800 corresponding test supplies

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