The health ministry is going after private physiotherapy clinics to recoup money it argues they wrongly billed OHIP.
In the latest volley in the war between the province and physiotherapists, the health ministry is going after private clinics to recoup money it argues they wrongly billed OHIP.
Letters aimed at recovering $104,600 were couriered to 45 clinics Wednesday after a three-month OHIP audit found more than half of the records did not support claims, according to documents obtained by the Star.
The province is looking at expanding the audit to cover a longer period of time, more clinics and records involving more services.
The recovery letters were sent a day before the clinics take the province to court in an attempt to quash a regulation that would stop them from billing OHIP as of Aug. 1.
The 2011 OHIP audit uncovered evidence that the province is using to bolster its case for reform. There is a suggestion the old system was vulnerable to abuse and had turned into a cash cow for some clinics.
“There is extraordinary growth in expenditures and the audit was one of those factors that just demonstrated to me that there were companies who were just taking advantage of the way the program was set out and taking advantage of their unlimited ability to bill OHIP,” Health Minister Deb Matthews said.
The province is overhauling the way it funds physiotherapy, taking away the authority of 91 clinics to bill OHIP, a practice that dates back to the 1960s.
The move has raised the hackles of the clinics, which have a lot at stake. They made $172 million in OHIP billings in 2011-2012 and are projected to pull in $200 million in the current fiscal year.
The audit looked at almost 15,000 records from the clinics and found that 58 per cent of them failed to support OHIP billings. It looked only at billings for in-home physiotherapy provided mainly to seniors living in settings such as retirement homes.
Documents show that in many cases OHIP was billed for physiotherapy when what was actually delivered was group exercise classes, often led by non-physiotherapists. Care plans were deemed substandard, record keeping was incomplete and appropriate physician referrals lacking.
The audit also found cases where OHIP was billed for what was described as “individual exercise programs” that lasted only five minutes and were delivered three times a week by non-physiotherapists.
Told about the audit results and ministry recovery plans in an interview, Tony Melles, spokesperson for the Designated Physiotherapy Clinics Association of Ontario, which represents the clinics in question, said it was the first he had heard of it.
He said he had no qualms about the province clawing back money it believes was improperly billed, but wishes the clinics had been informed about what was happening.
Melles, who is also president of Achieva Health, which owns and operates a number of the affected clinics, argued that the province is making a mistake with the reforms and warned that patients will suffer.
“I can’t figure out for the life of me how you can take that much money out of the system. (It) means we are going to have to let go staff . . . . Less physiotherapists, less physiotherapy assistants translates into less treatment,” he said, noting that clinics are in the midst of laying off 3,000 employees.
Though the province maintains it is increasing the physiotherapy budget by $10 million, Melles argues it is actually cutting funding by far more than that since the clinics have been billing OHIP for more than they were budgeted for in recent years.
Health Minister Deb Matthews said the physiotherapy dollar will serve more people under the reformed system.
The new system will see provincially funded physiotherapy offered in 200 clinics that will be more equally distributed across Ontario. The 91 existing clinics can still provide physio, but the OHIP-billing model will be replaced with one that involves transfer payment agreements with the health ministry.
Provincially funded physiotherapy will also be offered through home care, long-term care and primary care. As well, exercise classes for seniors will continue to be offered in retirement homes and other community settings.
Matthews noted that the Ontario Physiotherapy Association is onside with the changes and it’s only the clinics that are digging in their heels.
“When you do something like this, you know that those who have benefitted from the old model are going to invest very heavily in trying to put pressure on us not to make that change and that is exactly what’s happening. That’s what the pharmacists did, that’s what the OMA did,” she said referring measures taken by the province to lower the amount it pays for generic drugs and for some medical procedures.
Theresa Boyle – The Star – 2013-07-25.
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