Winnipeg doctor caught billing for patients he did not see

A prominent Winnipeg neurologist billed Manitoba Health for seeing patients he did not actually see, CBC News has learned.

Manitoba Health investigated the doctor's billing practices but will not say how extensive the incorrect billings were or whether the physician was required to pay back any money.

"It's wrong, it's just wrong," said patient Laura ​Brownson in an interview with the CBC News I-Team.

Brownson was referred to the neurologist, Dr. Brian Anderson, at the Stroke Prevention Clinic at St. Boniface Hospital in 2010 after suspicions arose that she'd had a stroke following a chiropractic treatment.

"I was afraid for my life. I was falling down, I lost all my close-up vision, I was seeing triple. I said, 'Please, I need to see a neurologist,'" she said.

Rather than seeing Dr. Anderson, the neurologist, Brownson was seen by Anderson's clinical assistant — a woman who had a degree in medicine from the University of Manitoba and six years of postgraduate training in neurology, but who was not a licensed doctor.

"When I tried to ask questions about why all these horrible things were going on with me, she was just rude," Brownson said. "My mother and myself believed she was a [licensed] doctor."

Brownson launched complaints with the College of Physicians and Surgeons of Manitoba about the care she received at the clinic. She argued that her symptoms, such as a lump on her neck and debilitating pain, were not properly diagnosed or treated.

In the course of investigating Brownson's care, college investigators discovered something she was not expecting: Anderson was in the practice of "billing for visits to the Stroke Prevention Clinic where the patient sees the clinical assistant."

Billed $142 for consultation

In Brownson's case, Anderson billed Manitoba Health $142.05 for an appointment, though he did not see his patient face to face.

Brownson was shocked.​

"I don't care if it was $500 or $5, he had no business billing for patients that he didn't see," she said.

If you feel … you haven't been treated right by a medical system, don't just sit there and do nothing.- Laura Brownson

CBC News asked another patient of the stroke clinic to obtain her billing records from Manitoba Health. Those records showed Anderson also billed for that patient on two occasions in 2012 — once for $142.05 and on a second occasion for $69.20.

A family member who accompanied the patient said she was seen by the clinical assistant but not by Anderson.

The college's investigation of Brownson's complaint concluded that Anderson was not obliged to examine Brownson himself, but should not bill for a patient to whom he did not personally provide a service.

"The billing manual is clear that a physician must provide a service to patients for whom they submit a billing," the college report states.

Anderson told investigators he was unaware of that rule and said he has changed his practice as a result. The college accepted his explanation.

CBC News requested interviews with Anderson and the clinical assistant, but both declined.

Report describes clinic's struggles

The College of Physicians and Surgeons' report outlined Anderson's reasoning for the improper billing. It paints the picture of a clinic struggling to see patients in a timely manner. 

The report said that rather than seeing patients in person, Anderson was spending time triaging patient referrals, reviewing patient histories and making the ultimate decisions about patient care.

"He does not think it is fair that his time is uncompensated," the report said.

However, the report noted that since the improper billing was discovered, Anderson "changed his practice in that he now sees all patients new to his clinic."

The report states that this new approach might reduce efficiency, but "Dr. Anderson finds he is much happier practising this way."

The college's investigation committee directed the college to send out a reminder to physicians about the rules for billing when a clinical assistant provides patient care, which did happen last summer.

The billing problems involving Anderson likely would not have been made public without Brownson raising them, because the college did not publish the findings of the case.

'Get another opinion,' Brownson says

Getting a diagnosis and treatment turned out to be a nightmare for Brownson. She received conflicting diagnoses.

The investigation report noted that a CT scan and MRI did not detect evidence of a stroke.

While several doctors held the opinion that Brownson did not suffer a stroke, two neurologists concluded that she did.

"This is a case where multiple specialists disagree on clinical findings and conclusion, which is not unusual in stroke," the college investigators concluded in their review of the clinical assistant.

Although the College of Physicians and Surgeons of Manitoba did not find that the medical care Brownson received at the St. Boniface Stroke Clinic was inadequate, it did find "significant cause for concern" over the communication Brownson had with the clinical assistant.

The report concluded that the clinical assistant "would benefit from communication skills training."  She was referred to get that training.

For Anderson's role, the report states that he "needs to monitor the quality of the interaction between the clinical assistant and the patient in view of this complaint."

In speaking publicly about her case, Brownson said she wanted to remind patients to be persistent if they have trouble getting effective treatment.

"If you feel, first of all, that you haven't been treated right by a medical system, don't just sit there and do nothing," she said. "You do not have to accept that."

Brownson added, "I can't say it enough: get another opinion."

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