SEVEN-YEAR HITCH: Why a $146,000 fraudulent OHIP billing case that began in 2014 is still going on

A seven-and-a-half-year-long case involving an Ontario physician found guilty of fraudulent OHIP billing worth more than $146,000 continues to drag on after the doctor filed an appeal with the Ontario Superior Court of Justice. Dr. Harmander Singh Gill, who practiced in Toronto and Brampton, has asked the court to quash the April 2021 decision of the discipline committee of the College of Physicians and Surgeons of Ontario to revoke his certificate of practice and to pay hearing costs of $124,440. He revised his appeal last month to add new grounds concerning an April 2019 hearing that proceeded in his absence and the discipline tribunal’s refusal to admit new evidence. The case dates back to April 2014, when the Ontario Ministry of Health and Long Term Care brought concerns about Dr. Gill’s billing and medical records to the attention of the college. According to college discipline documents, the ministry had found that Dr. Gill had billed for rapid strep tests much more often than his peers. Read: Alberta physician charged with allegedly over-billing the province between $3.5 million and $4.1 million An initial review of encounter notes for 17 patients who saw Dr. Gill on dates when he had billed for rapid stress tests found the documentation almost identical, with each patient’s temperature noted as 98.7 degrees Fahrenheit. All results were negative, and some of these patients were prescribed antibiotics while others were not. The college subsequently requested data on all claims paid to Dr. Gill from January 2011 to June 2015, and asked for a comparison of the number of rapid strep tests claimed by Dr. Gill against all general- or family practitioners who claimed that code. According to the college’s discipline committee document, this line of investigation found that: From January 2011 to June 2015, Dr. Gill billed for rapid strep tests 26,568 times, making this his second most frequently claimed fee code after intermediate assessments. Dr. Gill billed for rapid strep tests for as much as 75% of patients he saw in 2012 and 2013, and 69% of patients in 2014. Rapid tests were claimed for 46% of patients he saw in 2011 and only 12% in 2015. OHIP paid Dr. Gill $88,968 for rapid strep tests from March 2011 to May 2013, and $57,156 from June 2013 to March 2015, for a total of $146,124. Looking at the 25 patients who had the greatest number of claims for rapid strep tests, Dr. Gill submitted claims for 48 rapid strep tests for one patient between 2011 and 2014, and at least 31 claims for each of other 24 patients. In the case of patient, Dr. Gill made 20 claims for rapid strep tests in a single year. By comparison, more than 93% of general or family physicians in Ontario billed for rapid stress tests a total of 500 times or fewer from 2012 to 2015. Five physicians billed for the tests more than 10,000 times during this period. Dr. Gill was the only physician who billed for the tests more than 25,000 times. Read: Toronto doctor was out of line with out-of-hospital cosmetic procedures The college also found issue with Dr. Gill’s record-keeping. Most of his encounter notes were in the form of templates and original information unique to a patient was rarely entered, according to college documents. “The frequency with which Dr. Gill recorded ‘cough and cold x 3 days’ among his patients overall with individual patients defied belief,” the decision document stated. “Dr. Gill saw patient 1, for example, for 27 such visits in 16 months and on each occasion noted ‘cough and cold x 3 days.’ The encounter notes provided no support for the rapid strep tests that were documented in a high proportion of patients with ‘cough and cold x 3 days.’” A medical inspector retained by the college also expressed concerns with how Dr. Gill handled certain cases. In one of many examples, the medical inspector noted that Dr. Gill had failed to adequately monitor a patient’s diabetes, and appeared to have been unaware for as long as 18 months that he had not renewed a prescription for metformin. “There is no indication that he was aware of blood results that indicated the patient’s diabetes was poorly controlled until several months after the blood tests were done, or that he recognized that a fungal infection he treated should have raised a concern about whether diabetes was controlled,” the inspector reported. Testimony from some patients revealed they were never given the rapid strep tests Dr. Gill had billed for. Based on a calculation of Dr. Gill’s median daily patient intake and the length of time it would take for him to administer each test, the discipline committee concluded that it would have been physically impossible for him to do as many tests as he had billed for. A review of his medical supply orders along with interviews of his suppliers also found Dr. Gill had no more than 225 rapid stress test kits during the period in question. In April 2019, the discipline committee found Dr. Gill guilty of professional misconduct as well as incompetent. Two years later, in April 2021, the committee released its penalty decision. Read: $2.6 million overpaid to physicians and pharmacists: RAMQ investigation

SEVEN-YEAR HITCH: Why a $146,000 fraudulent OHIP billing case that began in 2014 is still going on

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