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Manitoba government not collecting overpayments to doctors, auditor general says

Manitoba's auditor general says the provincial government is not retrieving the vast majority of overpayments its makes to doctors. AP Photo/ Khalil Hamra

Manitoba’s auditor general says the provincial government is not retrieving the vast majority of overpayments it makes to doctors.

Tyson Shtykalo examined fees that physicians across the province were paid for patient examinations, surgeries and other services over a five-year period.

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In a report released Thursday, Shtykalo said the Health Department’s own auditing branch found $1 million in overbillings submitted by doctors, but only about $11,000 was collected — just over one per cent.

The government seems to focus more on educating doctors to avoid future overbillings than retrieving the money, he said.

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The report says the fee-for-service system is complicated and some mistakes are to be expected when there are billions of dollars in payments over a five-year period. But the Health Department has the authority to withhold future payments as a way to collect money it is owed by physicians.

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“The (Health Services Insurance Act) provides the department with the authority to offset overpayments against future claims from the physician.”

Even when the province goes after an overpayment, reimbursements are negotiated, the report says.

“We were told that the department starts by asking for 80 per cent of the amount owing and the physician suggests a much smaller amount. Eventually, an agreement is reached, resulting in a repayment lower than the original overbilled amount.”

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The group that represents the province’s doctors said it is committed to accurate billing.

“The auditor general’s report confirms the vast majority of physician billings — over 99.9 per cent — have not been found to be inaccurate or overbilled,” Doctors Manitoba said in a written statement.

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“Only an average of about $200,000 per year out of almost $1 billion in annual physician services has been flagged as potentially overbilled.”

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The group also questioned one part of Shtykalo’s findings. It said the $1-million figure for overbillings would include suspected cases that were later followed up and deemed correct.

“While it’s totally legitimate for provincial auditors to flag billing submissions as a potential overpayment, it’s important to note that in many cases physicians provide additional documentation that backs up their billing submission and the matter is resolved.”

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Shtykalo confirmed his figures refer to cases as they are initially flagged by Health Department auditors.

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His report makes six recommendations, including retrieving all overpayments, improving training for health department auditors, and doing more reviews of payments to physicians.

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The Health Department said it agrees with the recommendations. Many of the issues are addressed in a bill currently before the legislature, it said.

“Legislative amendments contemplated in Bill 10 are fundamentally aligned with the recommendations made by the (auditor general’s office) in its report,” the department said in a written response that accompanies Shtykalo’s report.

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