Physician Payment Review Board
File No. 16-PPR-0002
PRESENT: Ross Male, MD, Chair Suzanne Craig, Vice-chair Shawn Shu Kang Kao, MD, Board Member
Written hearing held December 13, 2018 and January 7, 2019
IN THE MATTER OF A REQUEST FOR HEARING under Section 18.3 of the Health Insurance Act, Revised Statutes of Ontario, 1990, Chapter H.6., as amended.
BETWEEN:
ADRIAN SAVIN, MD Applicant (Responding on the motion)
and
THE GENERAL MANAGER, ONTARIO HEALTH INSURANCE PLAN Respondent (Moving party on the motion)
DECISION AND REASONS
I. DECISION
This decision relates to a motion brought by the General Manager of the Ontario Health Insurance Plan (“General Manager” or “OHIP”) pursuant to Rule 8 of the Physician Payment Review Board’s Rules of Practice and Procedure to have the Board rule on its jurisdiction to hear this appeal.
It is the decision of the Physician Payment and Review Board (“PPRB” or “Board”) to grant this motion and deny jurisdiction to hear this appeal, without costs.
II. BACKGROUND
The following background facts are based on the written submissions of the parties and are not in dispute except where indicated.
Dr. Savin, the applicant in this proceeding and the respondent on this motion, requested a hearing before the PPRB pursuant to s. 18 of the Health Insurance Act, R.S.O., 1990, c. H.6 (the “Act”), after the General Manager denied sixteen claims for payment of fee code W010 for three patients (the “Claims”) on the basis that Dr. Savin did not submit the Claims within the prescribed time and form as provided in s. 18(3) of the Act. The Claims are for a management fee of $108.85/month for the three patients over differing periods from April-October 2013.
The General Manager brought a motion before the Board to dismiss Dr. Savin’s appeal on the basis that the Board does not have jurisdiction to hear appeals from a decision made by the General Manager under s. 18(3) of the Act. It is the General Manager’s position that a physician is only able to seek review of a s. 18(3) decision by application for judicial review before the Divisional Court.
Dr. Savin maintains he met the prescribed timelines and form required under s. 18(3) of the Act for initial submission of the Claims and given he provided the services, he should receive payment. He submits, among other things, that due to conflicting information he received from the Ministry of Health and Long-term Care of Ontario (“Ministry”) regarding how to correct the Claims, and difficulties in the requirements to claim fee code W010 for patients suffering from dementia, it was not possible to correct the Claims in the required time.
Dr. Savin is a family physician who practices in Toronto