Local doctor lauded as pandemic hero now on OHIP's hook for $600,000, 'crickets' from Ford government

Not only is OHIP demanding a local doctor pay back what she was reimbursed for running numerous vaccination clinics at the height of the COVID-19 pandemic, but the provincial government seems to have known about it for months yet has done nothing to right the apparent wrong.

When COVID vaccinations were developed in early 2021, General Rick Hillier was appointed to lead the province's vaccination task force and sounded a "call to arms" to fight the virus. 

Premier Doug Ford himself saluted Hillier, saying the task force, known as Operation Remote Immunity, "was launched to protect the most vulnerable populations in the province.” Ford lauded Hillier as a “master tactician” who was critical in getting the infrastructure in place to ensure the success of Ontario's vaccination program and “developing our vaccine distribution plan” with “mass vaccination sites, mobile and hospital clinics.”

Meanwhile, in Kingston, one of the people with boots on the ground in Hillier’s operation, Dr. Elaine Ma, was instrumental in helping to launch the largest vaccination roll-out in many generations, organizing multiple drive-through mass vaccination clinics. Like Hillier, she was hailed for her heroic efforts and received the Ontario College of Family Physicians Award of Excellence for 2021.

In the eyes of the Ontario Health Insurance Plan (OHIP), however, that apparently means little. OHIP now seems to be punishing Ma for the same actions she was lauded for at the height of the vaccine rollout.

When Kingstonist reached out to Ma to discuss her medical clinic's cancellation of a planned drive-through vaccination clinic this month, Ma revealed that she was now facing an OHIP Health Services Appeal and Review Board (HSARB), and the provincial-run insurance plan was asking her to pay back $600,000 for the clinics she ran at the height of the pandemic.

Local MPP sought government response months ago

Ted Hsu, Member of Provincial Parliament (MPP) for Kingston and the Islands, brought the situation out into the open during question period in the Ontario Legislative Assembly on May 15, 2024, and .

The May 15, 2024, Hansard of the 43rd Parliament, 1st Session details Hsu’s attempt to intervene on Ma’s behalf when he rose to speak on OHIP coverage of COVID-19 immunization.

He told his fellow parliamentarians, “In late 2021, COVID-19 cases skyrocketed in the Kingston area with the Omicron variant. An enterprising local doctor, Elaine Ma, ran a drive-through mass vaccination clinic. Community members, like my own daughter, volunteered to help. Thousands were quickly inoculated during a critical couple of days. That’s why I was shocked when I learned that OHIP asked Dr. Ma to pay back its $600,000 reimbursement. Why? OHIP said because shots were given in the St. Lawrence College parking lot, not in her office.”

Hsu also reminded the Assembly that this was not the first time this matter had been brought to the government's attention: “This is a follow-up to a letter to the minister [of health]'s office that I sent several months ago: Does our government have the backs of doctors who think out of the box and take the initiative to protect us during health emergencies? Would the minister intervene and override OHIP’s action and offer a fair solution?”

Speaker Ted Arnott recognized then-House Leader and Minister of Long-Term Care Paul Calandra, who answered quickly, “Of course, we’ll look into that. I know, in my own riding, we had a drive-thru vaccination clinic, which worked very well.” He then shifted to criticism of the former Liberal government's health record and of the New Democratic Party (NDP) for supporting the Liberals.

After much shouting in the legislature, Hsu again made his point, saying, “Mr. Speaker, this is not really a partisan question. OHIP asked Dr. Ma to repay about $600,000 in reimbursement for costs incurred. And $600,000 is about the cost for one COVID patient to stay a couple of months in the ICU. So that drive-thru clinic was a really cheap way to vaccinate thousands and prevent many additional COVID-19 patients going to the ICU. Dr. Ma followed the rules, the steps to qualify her mass clinic under the prescribed... billing codes and [Ontario Medical Association] billing practices for mass clinics. She is being punished for no good reason.”

Hsu reminded the government, "The minister of health [Sylvia Jones] has the power to conduct post-payment review. Will she intervene today? Will she set a healthy precedent so that in our next public health emergency, doctors who take the initiative to protect us in good faith can count on support from the system?”

After many interjections by parliamentarians on all sides and attempts by Arnott to regain order, Calandra again said the government would look into the issue, before launching another attack on the former Liberal government. 

Yet months later, Ma finds herself facing the Health Services Appeal and Review Board hearing in Toronto with no intervention by the government.

"I think our community greatly appreciated the innovative drive-through clinic held at the St. Lawrence College parking lot during the pandemic... Many of us have been disappointed that the government hasn't accommodated a reimbursement for that local health initiative, nor for the flu vaccination clinic this past weekend,” Hsu said in email correspondence with Kingstonist on Monday, Oct. 28, 2024, 

“We have been working with Dr. Ma behind the scenes for over a year now... The Health Minister has the power to make an accommodation, but so far has not intervened. Because the case is before the Health Services Appeal and Review Board with the hearing continuing this coming week, I will hold back some comments until after a decision is made."

Health/insurance law expert offers insight 

In the meantime, Kingstonist reached out to Erik Knutsen, a professor at Queen's Faculty of Law, in hopes of better understanding Ma’s situation. Health and insurance law are among Knutsen’s areas of academic interest, and he is a co-author of Stempel and Knutsen on Insurance Coverage, one of the leading American insurance law treatises.

While Knutsen admitted he could not be an impartial observer of Ma’s case because he is a friend of the doctor and has known about the case since it began, he was helpful in explaining the process Ma is now facing. 

“OHIP is the provincial organization that pays for our medical services. We tend to forget that, you know. Sure, It's public money, and everybody thinks health care is free, but there's a cost to it. The doctors and nurses are paid; they're paid per service,” he said.

The relevant law is the Health Insurance Act and the regulations thereunder, including the Ministry of Health Schedule of Benefits for Physician Services, Knutsen explained: “That sets out the rules of the game for what the province, through OHIP, will pay for and what it won't pay for. It's a long, complicated schedule... arrived at by agreement between the province and the Ontario Medical Association.”

He continued, “OHIP, as an organization with the money, follows this schedule of benefits, but as with lots of laws, sometimes what you're supposed to do in certain situations can be murky" --- and the pandemic was murky. 

“Everybody was told, and we had General Rick Hillier saying, ‘Get shots into arms, we'll sort it out after the fact. We've got to save people because they're going to drop like flies,'" Knutsen recalled. 

It was for that reason that Ma began organizing mass vaccination clinics. Knutsen pointed out that she organized, supervised, and ran the giant clinics, inoculating thousands, even on holidays such as Boxing Day and New Year's Day, and that her team of health-care professionals and medical students, including the Medical Officer of Health, took time away from their own families and homes during the holidays to care for the broader community.

He speculated that, two and a half years later, OHIP reviewed the documents, saw the huge number of people being treated in such a short period of time, and decided that it did not fit the rules. So, according to Knutsen, OHIP probably decided, "'Let's claw back all those thousands of shots that we paid Dr. Ma to do so effectively. She will earn $0 per shot because it didn't fit with the rules.'"

Knutsen pointed out that Ma had the full support of and permission from Kingston, Frontenac, Lennox and Addington (KFL&A) Public Health to run the clinics. He also noted "that if anything happened in one of those clinics,” such as a vaccination injury, "it was Dr. Ma who had taken on all of the liability." So to demand the money back as if the clinics did not even happen, "when she was saddled with that responsibility for those tens of thousands of shots, is kind of an odd thing."

And for OHIP to ask for the money back because the clinics didn't happen in a doctor's office is absurd, Knutsen said. "Nobody could be in closed spaces then; that was the point,” he said in an exasperated tone.

Not only that, but Ma has "compensated the teams of family doctors to come and help at her clinics as well as medical students," Knutsen added. "The money isn't the issue; it's that the work was done." If OHIP didn’t think Ma should be doing what she was doing, they could have told her right away, he said.

Former OHIP lawyer knows the process

Perry Brodkin, a health lawyer in private practice, stated, “The law is the only thing that matters to OHIP." And he should know; he was the sole lawyer for OHIP from 1973 to 1991.

Based on his experience, he explained the process that likely happened with this case and how he expects it will proceed.

First, Brodkin said, OHIP bureaucrats would notice this $600,000 bill as an aberration --- that such a massive charge would be unprecedented in the history of OHIP. 

“So they would come to me with this aberration, and I would say, 'What law applies?’ And then I would look for the law in 2020, 2021, beginning of 2022,” he said, noting that he would be working with physicians.

“We would go one meeting after another, and we would come to a conclusion [about which] are the relevant pages of the schedule... Based on that, we would decide yes, we are going to recover the $600,000, or no, we are not going to recover the $600,000."

“And then,” he said --- and this is the important part Ted Hsu and the people of Ontario need to know --- “We'd run it up the hierarchy because you want the assistant deputy minister, the deputy minister, and the minister [of health] to know." At first, Brodkin said he wasn’t sure it would go all the way up to the premier --- but in this case, Ma had told Kingstonist she had spoken directly to Premier Ford, and he said he felt she was being mistreated.

“Of course,” Brodkin said, “the litigation may not be concluded until 2029," at which time the current premier and health minister may not be around. 

He expects the hearing likely concluded yesterday (October 29), and we won’t know the decision until next year. After that, he said, it will be appealed no matter who comes out on top.

Kingstonist contacted local MPPs, OHIP, Minister of Health Sylvia Jones, and Premier Doug Ford on Friday, Oct. 25, 2024, for comments. At this time, only  MPP Hsu has responded.

Kingstonist will provide more on the hearing and its outcome, as well as further developments, as information becomes available.