Bulletin Number
        July 18, 2000
Direct inquiries to

         Ministry of Health
         Processing Office

(address below)
       Dental Surgeons
This Bulletin describes a number of changes affecting the Medical Review Committee (MRC) process, including:

1. Where a physician requests an MRC review, the physician is entitled to a review by a single MRC member if the amount in dispute is less than $100,000.

2. Application fees apply when a physician requests a review or a reconsideration by the MRC.

3. Other measures include interest charges, an additional amount for cost, and the publication of names.

The Minister of Health and Long-Term Care is accountable for fees paid to health care providers for services insured under the Ontario Health Insurance Plan. Improper claims are identified and the money is recovered.

Improper claims are identified through:

    • pre-payment computer rejections
    • routine computer screening of all physicians' paid claims
    • ad hoc computer extracts/analysis
    • service verification letters to randomly selected patients
    • complaints from the public
    • reports from other program areas of the Ministry
    • detailed analyses of the claims of individual physicians.

Improper and fraudulent claims are controlled post-payment through:

    • referral for review by the MRC, with recovery of fees paid inappropriately
    • direct recovery by the General Manager of OHIP of fees paid inappropriately when MRC investigation not required (Note: a physician can request that the MRC review the General Manager’s refusal, reduction or recovery of payments)
    • referral to the Ministry’s Investigation Unit when criminal fraud is suspected.

Physicians who have questions about the appropriate claim for a given service should contact their regional OHIP office for clarification. It is in the best interest of the physician to seek that clarification, or at least have it confirmed, in writing. If the Monitoring and Control Section of the Ministry contacts a physician to discuss questionable claims, that also presents an opportunity to resolve any misunderstandings.


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K7L 5A9
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N6A 1B7
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North Bay
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Fuller Building
75 Albert Street
K1P 5Y9
Owen Sound
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N4K 2H5
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K9J 8J8
St. Catharines
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L2R 3C3
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N7T 5W4
Sault Ste. Marie
Roberta Bondar Place
70 Foster Dr., Ste. 100
P6A 6V4
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Suite 801
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Thunder Bay
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Suite 113
P7E 6T1
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P4N 6K6
2195 Yonge St.
P.O Box 1700 Stn. A
M5W 1G9
1427 Ouellette Ave.
N8X 1K1
Head Office
P.O. Box 48
Kingston, ON
K7L 5J3