A Toronto doctor, whose fees were tens of thousands of tests, authorities say he has never done or subjected other patients to many unnecessary procedures, CTV News has learned.
The case illustrates weaknesses in the province’s ability to detect suspicious claims and recover millions lost from those that could ruin the medical system, according to critics.
Dr. Ayokunle Fagbemigun was among the best payers in Ontario for several procedures at his second-floor office in North Etobicoco, but he never acquired the materials to perform many of them, according to a disciplinary decision.
The doctor also prescribed several tests to the patients that they did not need, there were no documents to support his decisions to provide them and he could not explain why he tested patients at the age of nine and offered another patient eight pregnancy tests after one year. although she was not sexually active.
“Dr. Fagbemigun charges for services he has not provided and charges fees for referral to a cardiac care provider. He put inaccurate information in patients’ charts and sent his patients for unnecessary tests that could cause them anxiety, time and inconvenience, “the Ontario Disciplinary Tribunal for Physicians and Surgeons said in a decision issued in March.
“He did this for his own financial gain, at the expense of caring for his patients and the public health system. He deliberately received many thousands of dollars to which he was not entitled, “the decision reads.
Arriving at his office in Etobico, Dr. Fagbemigun opened the door and then waved to a reporter and photographer from CTV News Investigates. His secretary confirmed in a phone call that the doctor was not interested in talking to the press.
Investigators from the College of Physicians and Surgeons in Ontario went down to his office in 2018, took pictures and cleaned hard drives, according to one of several decisions in the case.
They compared his invoicing records for four years with his supply ordering records to find that he had not ordered enough to complete the procedures he had performed.
Of the 2,385 pregnancy tests he claims he did, he bought enough material for only 225, leaving 2,160 unknown. Of the 6,085 rapid streptococcal tests he claims he did, he bought enough material for 125, leaving 5,960 in the dark. He claims to have performed 10,016 drug tests, but bought enough materials for 75.
In all, authorities found that he charged 42,085 for procedures he could not perform, the ruling said. CTV News analyzed the invoices to find that the total amount of taxes paid that met the procedures was between $ 270,000 and $ 410,000.
In some procedures in 2018, he filed more than twice as many claims as the next highest payer, the decision said, while in 2017 he charged almost three times.
But the unusual charging pattern was not caught by the provincial authorities. Instead, a federal audit, in part because of his care for refugees and others covered by federal plans, led to his being recommended for provincial discipline.
This is a symptom of poor oversight and major audit gaps, said NDP health critic Francis Gelinas, citing numerous reports by the province’s chief auditor from 2016 that illustrate a failure to spot and then receive funding from doctors for whom it is found to overestimate the public health system.
“We have very good doctors who charge appropriately, but we have a few bad apples and very little has really been done to recover the money. “We are talking about millions of dollars in improper and fraudulent charging,” she said.
The provincial government declined to comment while Fagbemigun’s case continues. The Ontario Medical Association said it expects members to charge according to OHIP rules.
Fagbemigun continues to practice and examine patients. The disciplinary panel has retained a decision on what punishment will be imposed on him.
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