Extra billing sometimes a ‘misunderstanding,’ Ontario health minister says

As Ontario continues with its plan to significantly expand the role of private, for-profit clinics in the province, the health minister says cases of wrongful extra billing can come down to a “misunderstanding.”

Minister of Health Sylvia Jones said Wednesday that the number of complaints about wrongful billing in the province is “minuscule” and suggested they may not be malicious.

“I wouldn’t use the word ‘bad actor,’” Jones said

“I would say, in some cases, it is a misunderstanding about what is covered and what is not. And when those conversations happen, the patient is reimbued and the clinic or clinician who has done it gets that education because we want to make sure people have access.”

Data previously shared with Global News by the Ministry of Health shows that, since the Ford government took power in 2018 until 2022, around $70,000 in medical fees were been found to violate legislation that outlaws charges for procedures or services already covered by public insurance.

Of that number, $42,000 in charges at clinics were deemed violations of legislation since the 2018-2019 year. A total of $225 charges from independent health facilities were found to be wrong.

The data’s definition of a clinic could include spaces that previously held an independent health facilities license but were no longer licensed under that structure when the numbers were collected.

The Canadian Press previously reported that from 2020 to 2022 there were 68 complaints, with 15 of them about charges for eye exams and 13 of them related to cataract procedures. Other complaints involved a range of medical procedures including blood tests and prenatal testing.

A recent freedom of information request filed by CTV Toronto was returned with the names of the clinics or health practitioners found guilty of wrongly charging patients hidden.

Asked Wednesday if she would release the names of those who had overbilled, Jones said she wanted to “keep a perspective” on the number of complaints.

“As we do those investigations, the individuals who were improperly charged for OHIP-covered service do get their funds returned,” Jones said. “And the facilities that are doing improper OHIP charging are pulled back and disciplined. I think it’s really important that we let that work continue because it has been in place for many, many years and it is a system that works.”

Jones said roughly 600,000 OHIP interactions take place in the province daily.

The data shared with Global News shows that between 2012 and 2022, an average of 101 complaints were filed annually and roughly 43 were upheld.

Ontario NDP Leader Marit Stiles said the issue needed to be addressed and those who had broken the rules should be named.

“There are bad actors out there, these are illegal ees and the government should be cracking down on it,” she said.

“I absolutely think those clinics should be named, I don’t know how else you go about cracking down on that kind of bad behaviour unless you’re actually able to call them out for it.”

Liberal MPP John Fraser said he felt those overbilling for OHIP-covered services “know what they’re doing” and should be named.

“I think it’s important for Ontarians to have that information, I think that’s important,” he said. “Let’s be open and transparent about it.”

The Ministry of Health is working on regulations that will bring elements of its Your Health Act into effect. The legislation, which was passed in the spring of 2023, expands the role of for-profit clinics in the delivery of health care.

Cataract surgeries and diagnostic imaging and testing are all expanded by the health care reform law, while the government will create an entirely new system to perform hip- and knee-replacement surgeries.

In January, Jones unveiled a new accreditation and inspection process for private facilities that can offer taxpayer-funded procedures.

A spokesperson for the minister of health previously confirmed a general call for new licences of private clinics and facilities would begin in the spring.

“Over the coming weeks, the province will consult extensively with health care sector partners, regulatory colleges representing providers, and patients and families on the development of the new oversight and quality assurance program,” the province said in a January statement.

— with files from The Canadian Press

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