Originally published in The Ottawa Citizen April 22, 2003
Original Title: The Death of Tony Hsu

Dr. Tony Hsu, a Welland pediatrician in practice for 30 years died last week, his body recovered from Lake Ontario. Humiliated and abused by the Medical Review Committee (MRC), his plight, profiled by CTV’s Avis Favro last November, showed us a caring and dedicated physician destroyed by the committee. Dr. Hsu worked on-call one every two nights, provided free service to the Children’s Aid Society and was respected and admired by his patients and colleagues alike.

Last December I wrote about the draconian MRC. The MRC has a mandate from the Minister of Health to “go after” physicians who do not fit a particular computer program billing practice profile. This program will digest and average out the number of specific fee codes a family doctor or specialist should bill in a year. It flags any significant deviation from the “specialty average”. These deviations can occur because of different patient demographics, location of practice (rural North versus Urban setting), the physician’s area of interest or fraud.

The MRC is not a judiciary body. They do not have to listen to evidence, legal arguments or expert opinion. The physicians under investigation have provided the service to their patients. There are no fraudulent acts. Indeed, fraudulent actions are the domain of the Anti-Rackets Squad of the Ontario Provincial Police, not the MRC.

Whatever the reason for the computer flag, the General Manager of OHIP may decide to send a letter to the physician stating he believes the physician has been overbilling for several years. The letter will sometimes state that for a large sum of upfront settlement money, they will drop the file. Should you not agree to make an offer they cannot refuse, the general manager refers the matter to the MRC.

If the physician wishes to mount a defence and submit to a full review, he/she must bear the costs of the entire proceeding.

The physician must prove their innocence instead of the onus on the MRC to prove guilt. Even if only one of the hundreds of reviewed billings is deemed in error, the physician will have to pay all legal costs including the $1000 per day cost of the auditor(s).

Once proclaimed “guilty” the physician must pay back OHIP within one year all overbilling with interest including the MRC and OHIP legal costs (about $15,000 to $25,000) irrespective of an appeal. Exoneration is a rare event.

Should the physician not have sufficient funds to pay the penalty, the government will seize their assets. Further, the MRC can re-audit the physician for a different billing period for the same perceived infraction.

These physicians, aptly described by Dr. Doug Mark, president of the Coalition of Family Physicians, are the “Living Dead”.

The computer flagged Dr. Hsu because he allegedly billed more annual check-ups than the average. What the computer did not reveal was that he billed one-third less consultation fees. In other words, he billed less than his counterparts.

He had to pay back $108,000; close to his yearly net income. He had to cash in part of his RRSP lest the government garnish his entire yearly salary or seize his RRSPs. Dr Hsu was not a criminal, did not commit any fraudulent acts, honestly provided the medical services and diligently served his community. His crime according to the MRC was that did not write enough chart notes to justify billing for an annual check-up although he did perform the check-up. The MRC did not consider the letters of support from his patients and colleagues.

In a prophetic statement last November, Dr, Hsu wrote about the effect the MRC has had on physicians.

“The targeted physicians were by majority hardworking, accountable community pillars with over 15 years in practice. The allegations of wrongdoing were devastating to the unsuspecting physicians.

Initial reactions of disgrace, shame and humiliation were followed by self-doubt as to lifelong misinterpretation of acceptable billing methodology. All experienced overwhelming stress, questioned on what defined fraud, and considered the event an attack of personal integrity. These led to decreased professional work, family disruption, major clinical depression, constant anxiety and post-traumatic stress disorder akin to being subjected to repeated rape. Some practitioners opted for early retirement or gave up hospital privilege. Medical-legal intimidation paranoia was common.”

This trampling of basic human rights and unconstitutional actions destroys the careers and now the lives of Ontario doctors. Canadians are fair-minded people and should be outraged that Soviet-style justice or the English witch-hunting trials of 1650 exist in our country.

Rest in peace Dr. Hsu. Your death will not be in vain.

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© Dr. Barry Dworkin 2003