Nine Ontario specialists claimed that they worked more than 360 days last year, according to the provincial auditor’s annual report.

Among them were six physicians who billed the Ontario Health Insurance Plan for work they say they did on 366 days during the 2015/16 fiscal year (which had an extra day because 2016 is a leap year).

Ontarians are not allowed to know the names of these doctors because the government keeps them secret.

The Star has been trying since April 2014 to get the names of the highest billing doctors released. Earlier this year, the province’s privacy commissioner ruled in favour of an appeal by the Star, but three groups of doctors, including the Ontario Medical Association, are seeking to have that decision overturned. The case is headed to divisional court next year.

In releasing her annual report on Wednesday, Provincial Auditor Bonnie Lysyk said oversight of fee-for service payments to doctors is “weak” and that the health ministry does not investigate many “anomalous” physician billings.

The auditor found 648 specialists whose 2015/16 billing trends were anomalous when compared to the expected range of days billed and services provided by specialty category. Among them:

- A respirologist who worked for 361 days billed the province $1.3 million, close to five times more than the upper expected limit. The respirologist made claims for close to 12,400 services, about four times the upper expected range for the same billing category.

- A cardiologist who worked 354 days and billed the province $1.8 million, three times more than the upper expected limit for physicians in the same billing category. This cardiologist provided more than 13,200 services, 2.4 times the upper range of expected services for physicians billing in the same category.

- A diagnostic radiologist worked 313 days and billed the province $1.7 million, which is 2.8 times the upper expected limit for physicians in the same category. This specialist provided more than 57,400 services that year, 5.6 times the upper range of expected services for physicians in the same billing category.

Staff from the provincial auditor’s office were told that the health ministry does not investigate many cases of anomalous billing because it requires too much time and effort.

But among the eyebrow-raising cases the ministry has identified are more than 500 physicians who billed OHIP for more than $1 million in 2014/15.

“The ministry suspected that some of these billings might have been inappropriate: for instance, medically unnecessary services might have been performed or payment made for services that had not been rendered, or the standard of care might have been breached in other ways,” the auditor’s report reads.

It cites the case of an ophthalmologist who billed $6.6 million in 2014/15 and who has previously been described by Health Minister Eric Hoskins as the province’s highest billing doctor.

The majority of this ophthalmologist’s billings came from performing laser procedures. The ophthalmologist performed the procedures on average seven times per patient over the year. This doctor also billed $1.4 million for diagnostic testing.

“Ordering unnecessary diagnostic tests by ophthalmologists is cited for caution by the Choosing Wisely national health campaign in the U.S. and Canada. Choosing Wisely encourages conversation between physicians and patients about unnecessary tests, treatments and procedures,” reads the annual report.

The report said that since the beginning of 2013, the ministry has not proactively pursued recovering of overpayments.

Lysyk has advised the province to evaluate the costs and benefits of amending the fee-for-services billing review process and re-establishing an inspector function to oversee physician billings.

It’s a controversial suggestion and one the province has said it will consider.

“There are currently strong tools in place to review and investigate discrepancies in physician billings, including routine monitoring of anomalies. However, there are opportunities to enhance these oversight measures,” Hoskins said.

The province has had no inspector function since 2005 when it disbanded the Medical Review Committee.

That move was made on the recommendation of retired Supreme Court Justice Peter deCarteret Cory who reviewed the auditing process and found it to be debilitating and devastating to physicians. His review followed the suicide of a Welland pediatrician who had been audited.

OMA president elect Dr. Stephen Chris said the government already has tremendous ability to assess and audit physician practices and deal with anomalous, inappropriate billing.

He noted the existence of the Physician Payment Review Board, which is charged with adjudicating over payment disputes.

“The government has never referred anybody to it,” Chris said.

“I think the government has the tools and has the desire to do whatever they can not to pay inappropriately, which we wouldn’t have any trouble with,” he added, charging that the health ministry is bureaucracy heavy.

There is no suggestion outliers are working inappropriately, Chris said.

“We don’t have an in-depth understanding of how these individuals are working. That is information that is not available, but if the government hasn’t acted on it, there must be some explanation,” he said, adding that it’s possible some communities require an intense level of specialty services.

Lysyk questioned why taxpayers are footing so much of the bill for physician medical liability insurance via the Canadian Medical Protective Association. The province has more than doubled its payments for this insurance over the last three years, forking out $329 million this year, up from $145 million in 2013.

The auditor also found problems with a patient-enrolment payment model adopted by the province about a decade ago. Last year, it cost $522 million more than it would have under the traditional fee-for-service model. That’s in part because 1.8 million patients enrolled in these group practices did not see their physicians during the year, yet the doctors were paid $243 million for having them enrolled.