A Canada-based Nigerian medical practitioner, Dr Ayokunle Fagbemigun is in the news for awful reasons. He has been found to have billed the Ontario Health Insurance Plan (OHIP) for supposedly drug screening patients as young as nine-year-old. OHIP is the government-run health plan, which is paid through taxes.
Toronto Sun reports that Dr Fagbemigun claimed he gave eight pregnancy tests in one year to another patient who was not even sexually active.
For billing for 42,000 tests he never performed, the family doctor has been stripped of his licence to practise medicine and ordered to pay back $35,000 to the Ontario government, the maximum fine that the Ontario Physicians and Surgeons Discipline Tribunal can impose — but a paltry amount compared to the estimated hundreds of thousands of dollars Fagbemigun stole from taxpayers.
The chances that he would be compelled to reimburse every dime are slim.
“This tribunal has no power to order Dr Fagbemigun to repay the monies he took”, the panel wrote. “That is a matter for the courts, if OHIP decides to pursue it”.
“Dr Fagbemigun misconduct is extremely serious”, the tribunal stated in its penalty decision released last week. “He took hundreds of thousands of dollars from the health care system to which he was not entitled. He did so intentionally, and for his personal gain. He defrauded the government many times over an extended period”.
The panel also found that he betrayed patient trust by sending them for cardiac tests so he could pocket referral fees.
“The tribunal would be failing in its duty to protect the public if it allowed Dr Fagbemigun to continue to practise medicine”, the panel concluded.
According to the ruling, Fagbemigun has been working six days a week as a sole family practitioner in Etobicoke since 2015, with his patients largely from Africa or the Caribbean. An investigation by the College of Physicians and Surgeons found that between 2014 and 2018, he billed for thousands of tests and procedures he never performed, including urine pregnancy tests, urinalysis, rapid strep test, urine drug screen and ear wax syringing.
Compared to other family doctors, his OHIP billings stood out like a red flag. In 2016, 2017 and 2018, Fagbemigun was in the top 0.5 percent of General Practitioners (GPs) who billed for strep tests. For ear wax removal, Fagbemigun made more claims than all 11,000 GPs who billed that code: in 2018, he made more than double the claims as the second highest biller; in 2017, it was almost triple.
Yet an analysis of his medical supply purchases didn’t come even close to matching the claims.
Between 2016 and 2018, for example, Fagbemigun submitted almost 4,000 claims to OHIP for nerve conduction tests. But between purchases and free samples, he only had a record of having 240 of the biosensors needed for the machine. Not only that, the device he used was not even eligible for payment, the tribunal found.
“Billing double or triple the next highest physician and the volume of OHIP claims for the same patients and procedures many times in the year support the conclusion that flows from the other evidence that he did not actually carry out all of these procedures”.
An audit of his 2017 billings found 23 patients supposedly had more than five pregnancy tests that year and 84 patients purportedly had their ears syringed more than 10 times.
“Routine administration of drug screening on patients as young as nine years old is not warranted and eight pregnancy tests in a year for a patient for whom there is no documentation of being sexually active is a waste of resources, assuming the tests were actually done”, the tribunal found.
Last year, Dr Harmander Singh Gill also had his medical licence revoked in part for overbilling OHIP to the tune of more than $146,000. He was caught billing for the rapid strep test more than any other family/general practitioner during the period of 2012-15.
And not a little bit more. While more than 90 percent of his peers coded it 500 times or less during that period, Gill claimed the fee code a staggering 25,000 times.
Credit: Toronto Sun