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Former Sussex doctor takes case on order to repay $ 500,000 in bills

Written by Javed Iqbal

A former family doctor in New Brunswick, who closed his Sussex practice in February, had been ordered to reimburse the health ministry more than $ 500,000 in Medicare bills.

Dr. Sunita MacMullin, who now practices in Ontario, was told she was charging too much in the province after a review of her fees per.

MacMullin has consistently been one of New Brunswick’s highest-earning physicians in recent years, billing the province for about $ 1.8 million in 2020 and $ 1.6 million in 2021.

The doctor began taking legal action against the province in March following another planned revision of her 2016-2019 bills. She asks the court to cancel the review of additional records during this period and to ban further reviews until an appeal for the refund of invoices is processed.

The doctor is also seeking disclosure of the province’s records related to the review of her 2016-2019 bills, according to documents filed with the Court of Queen’s Bench in Moncton.

Moving practice to Sussex

MacMullin worked as a family physician in Fredericton until 2018, when she moved her practice to Sussex. She said she had too many patients and lacked “guard” support from other doctors.

She had worked in both family and emergency medicine in the province since 1999, and she had also seen patients in a special nursing home, according to her statement.

While in Sussex, MacMullin said in her statement that she “always ran a busy practice” and “worked very long hours.”

In 2019, Medicare contacted her to request a review of billing between April 1, 2016 and March 31, 2019. The doctor said she attended “without hesitation,” giving full access to officers who visited her clinic over four days. It found no discrepancies.

Audit finds lack of documentation

So in 2021, she participated in a further revision. Medicare staff visited her clinic for about two weeks.

In December 2021, the Ministry of Health MacMullin sent a letter explaining its assessment of 1,078 claims from 2019-21, selected at random. The document filed in court explains why some visits did not meet the requirements to be covered by Medicare, such as lack of documented test results, elective procedures and virtual care.

It said the audit showed a general lack of supporting details and documentation for treatment plans.

MacMullin said in her statement that she believed Medicare may not have or understood all the information necessary to fully understand her billing, and requested additional time to respond to an initial observation letter regarding the audit.

‘I felt bad’

On February 24, she was informed by her attorney that Medicare was seeking payment of a claim of $ 552,315.80 within 30 days.

Outstanding amounts were garnished in February and March, reducing the total amount to about $ 428,000, according to court documents.

The province also announced to MacMullin that it would conduct another review of 2016-19 invoicing.

Shortly after the refund order, MacMullin Horizon Health announced that she was quitting her Sussex practice.

“As the stress of these Medicare cases became unbearable, I felt uncomfortable. I was no longer safely able to practice medicine in these environments,” she wrote in the statement.

“I’m very proud of my work in New Brunswick. I took care of my patients. I took my billing responsibilities seriously. If I made billing errors, I have no objection to repaying those claims to Medicare.”

Review unreasonable, says the doctor

MacMullin’s announcement of application said she fully complied with the original 2019 audit, which allowed access to staff, books and records.

She said she has repeatedly searched for the province’s audit file for 2019 of her bills.

The court’s cases include a letter from the province sent in October 2019. It said that the 2016-2019 review of fee-for-service invoicing resulted in “no adjustment or recovery” of claims, noting that the documentation from her office was “clear, organized and consistent in nature.”

In the application, MacMullin said that the Ministry of Health has already reviewed the period 2016-2019 and that the further review is outside the scope of the Medical Services Payment Act. She said the further review is “unreasonable” and a “breach of authority”.

MacMullin’s lawyer did not respond to a request for comment.

The province has not filed a response and the next hearing is scheduled for November 17.

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Javed Iqbal

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