Ontario doctor billed for 42,000 tests he didn't do, investigation finds

A Toronto doctor billed for tens of thousands of tests authorities say he never performed, and subjected other patients to scores of unnecessary procedures, CTV News has learned.

The case illustrates what critics say are weaknesses in the province’s ability to find suspect claims and recover millions lost to those who could be bilking the medical system.

Dr. Ayokunle Fagbemigun was among the top billers in Ontario for several procedures at his second-floor office in North Etobicoke, but never actually acquired the materials to perform many of them, a disciplinary decision says.

The doctor also administered to patients several tests they didn’t need, didn’t have documents to back up his decisions to provide them and couldn’t explain why he was drug testing patients as young as nine years old, and offering another patient eight pregnancy tests in a year, even though she was not sexually active.

“Dr. Fagbemigun billed for services he did not provide and took referral fees for referrals to a cardiac care provider. He put inaccurate information in patient charts and sent his patients for unnecessary tests that could cause them anxiety, time and inconvenience," said the Ontario Physicians and Surgeons Discipline Tribunal in a decision issued in March.

"He did this for his own financial gain, at the cost of his patients’ care and the public health care system. He intentionally received many thousands of dollars to which he was not entitled,” the decision read.

Reached at his office in Etobicoke, Dr. Fagbemigun opened the door, and then waved away a reporter and photographer with CTV News Investigates. His secretary, in a phone call, confirmed the doctor wasn’t interested in talking to the press.

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Investigators with Ontario’s College of Physicians and Surgeons descended on his office in 2018, taking photographs and sweeping up hard drives, one of several judgments in the case says.

They compared his billing record over four years with his records of ordering supplies to find that he didn’t order enough to perform the procedures he did.

Of 2,385 pregnancy tests he claimed to have performed, he only bought enough materials for 225, leaving 2,160 unaccounted for. Of 6,085 rapid strep tests he claimed to have performed, he bought enough materials for 125, leaving 5,960 unaccounted for. He claimed to have performed 10,016 drug tests, but only bought materials enough for 75.

In all, authorities found he billed 42,085 procedures he could not have performed, the decision says. CTV News analysed the billings to find the total amount of tax dollars that were paid that corresponded to the procedures is between $270,000 and $410,000.

In some procedures in 2018, he was making more than double the claims as the next highest biller, the decision says, while in 2017, he was billing almost triple.

But the unusual billing pattern wasn’t caught by provincial authorities. It was instead a federal audit, partially because of his care of refugees and others who are covered by federal plans, that resulted in him getting referred to for provincial discipline.

That’s a symptom of lax oversight and major gaps in audits said the NDP’s Health Critic Frances Gelinas, pointing to multiple reports by the province’s auditor general starting in 2016 that illustrate a failure to notice and then to obtain funds from doctors who have been found to overcharge the public health-care system.

“We have a ton of very good physicians who bill appropriately but we have a few bad apples, and really there is very little that has been done to recoup the money. We’re talking millions of dollars in incorrect and fraudulent billing,” she said.

The provincial government declined to comment while Fagbemigun’s case is ongoing. The Ontario Medical Association said it expects members to bill in accordance with OHIP rules.

Fagbemigun continues to practice and see patients. The disciplinary panel has reserved a decision on what penalty he will face.