A top-billing doctor charged OHIP for doing an eye procedure more times than all other MDs combined. Another billed for 128 laser treatments in one day. The numbers have some medical experts baffled
2019-07-05 from thestar.com
Chatham ophthalmologist Christopher Anjema has billed the Ontario Health Insurance Plan for treating patients suffering from common eye problems such as cataracts and glaucoma.
He has also charged the province for doing a not-so-common eyelid reconstruction procedure — again and again.
Known as a Tenzel flap, it’s performed when a patient is missing a hunk of flesh from an eyelid, often because cancerous skin had to be removed. The surgeon makes a small, semicircular incision beside the eye to be able to slide some extra tissue over to repair the eyelid.
Anjema, one of Ontario’s top-billing doctors, charged the province between 2011 and 2018 for 3,305 treatments under the fee code associated with the Tenzel flap, according to billing data released by the Ministry of Health and Long-Term Care.
That’s more than all of the other doctors in the province combined, including the oculoplastic surgeons who specialize in these kinds of procedures.
“That’s more than most busy oculoplastic surgeons do in a career,” said Dr. Timothy McCulley, chief of oculoplastics surgery at the renowned Johns Hopkins Wilmer Eye Institute in Baltimore.
McCulley says he performs fewer than 10 Tenzel flaps a year. Anjema, who refused repeated requests for comment from the Star, has billed for as many as 26 in a single day, according to the ministry data.
A Star investigation has found Anjema and at least two other top-billing doctors have charged tax-funded OHIP for procedures or tests at frequencies much higher than what experts say is standard or, in some cases, even possible.
At least two of the doctors’ billings were flagged by an internal Ministry of Health audit in 2016, which examined whether they were “upcoding” — charging OHIP using fee codes for more expensive procedures.
The audit noted concerns that the high-billing doctors may be charging for procedures that were “medically unnecessary” or had not actually been done. One of the doctors says the auditors found “nothing improper” with his billings.
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