A Toronto doctor who billed tens of thousands of tests, authorities say he never did, and subjected dozens of other patients to unnecessary procedures, CTV News has learned.
The case illustrates what critics say is a weakening of the province’s ability to find suspicious claims and recover millions lost by those who could scam the medical system.
Dr. Ayokunle Fagbemigun was among Ontario’s top billers for various procedures in his second-floor office in North Etobicoke, but he never acquired the materials to perform many of them, according to a disciplinary decision.
The doctor also gave patients several tests they did not need, had no documents supporting their decisions to provide them, and could not explain why he was testing drugs on patients as young as nine and offering another patient. eight years. pregnancy tests in one year, although she was not sexually active.
“Dr. Fagbemigun billed the services it did not offer and charged referral fees for referrals to a cardiac care provider. He put inaccurate information on patient records and sent his patients unnecessary evidence that could cause them anxiety, time and inconvenience, “the Ontario Medical and Surgeon Disciplinary Court said in a March ruling.
“He did this for his own financial gain, at the expense of the care of his patients and the public health system. He intentionally received many thousands of dollars to which he was not entitled,” the decision read.
Arriving at his Etobicoke office, Dr. Fagbemigun opened the door and then waved away a journalist and a CTV News Investigates photographer. Her secretary, in a phone call, confirmed that the doctor was not interested in talking to the press.
Investigators from the Ontario College of Physicians and Surgeons went down to his office in 2018, taking photographs and sweeping hard drives, according to one of several rulings in the case.
They compared his billing record for four years with his supply order records to find that he did not ask for enough to complete the paperwork he did.
Of the 2,385 pregnancy tests he said he had performed, he only bought enough material for 225, leaving 2,160 unaccounted for. Of the 6,085 rapid streptococcal tests he said he had performed, he bought enough materials for 125, leaving 5,960 unaccounted for. He claimed to have performed 10,016 drug tests, but only bought enough material for 75.
In all, authorities found that he billed 42,085 procedures that he could not have performed, the decision says. CTV News analyzed the bills to find that the total amount of tax dollars paid that corresponded to the paperwork is between $ 270,000 and $ 410,000.
In some proceedings in 2018, he was making more than twice as many claims as the next biller, according to the decision, while in 2017, he billed almost three times as much.
But the unusual billing pattern was not captured by the provincial authorities. Instead, it was a federal audit, in part because of his care for refugees and others that are covered by federal plans, that resulted in him being referred for provincial discipline.
This is a symptom of lax oversight and large gaps in audits, said NPD health critic Frances Gelinas, who noted several reports from the province’s auditor general from 2016 that illustrate the lack of notice and after obtaining funds from doctors who were found to be overcharging. the public health system.
“We have a lot of really good doctors who bill properly, but we have some rotten apples, and very little has really been done to get the money back. We are talking about millions of dollars in incorrect and fraudulent billing,” he said.
The provincial government declined to comment while Fagbemigun’s case is ongoing. The Ontario Medical Association said it expects members to bill according to OHIP rules.
Fagbemigun continues to practice and see patients. The disciplinary court has reserved a decision on what sanction to face.