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Providers who have been directed to repay funds following a review committee review are also subject to :

  • An interest charge on the amount of repayment, and
  • A charge towards the cost of the review.

Providers who have been directed to repay funds following a panel committee review may be subject to :

Publication of the review committee case.

The Health Insurance Act authorizes the General Manager of OHIP to publicize information about providers who have been directed by a panel of a Medical or Practitioner Review Committee to repay money received for improper claims. This Bulletin contains the first release of this information.

The following information pertains to optometrists who appeared before a panel of the Optometry Review Committee for a review of services provided on or after May 1, 1996, and who have been directed to repay claims to OHIP as of March 31, 2002.

Region where services under review provided : Region where provider currently practising : (as of 07/31/01 Period of Review: mm/dd/yy Codes Reviewed :
Referred to Review Committee :
Codes Reviewed :
Contained in Review Committee Direction :
Recovery Amount*:
Central South Central South 08/01/97 to 07/31/99 V401, V402, V404, V405, V406 V401,V402, V404, V405, V406 $12,874.16
Central East Central East 08/01/97 to 07/31/99 V401, V402, V404, V405, V406 V401, V402, V404, V405, V406 $23,520.60
Central South Central South 01/01/00 to 01/31/01 V401, V402, V404, V405, V406 V401, V402, V404, V405, V406 $42,982.38

*The recovery amount only includes amounts that pertain to services provided on or after May 1, 1996.

Providers are reminded that s.37.1 of the Health Insurance Act requires that records be maintained to establish :

  • whether an insured service was provided
  • ,
  • whether the service was therapeutically necessary,
  • that the service claimed is the same as the service provided.

This section of the Act requires that records be created promptly when the service is provided and that in the absence of a record the fee payable is nil.

Providers who have questions about claims for a given service are encouraged to contact their District Office and obtain clarification in writing.

More information about the review committee process is contained on the ministry website : http://www.health.gov.on.ca



Ontario Ministry of Health and Long-Term Care
© 2002 Queen's Printer for Ontario  |  Last Modified:  06/15/2009 09:54:22