Ontario Superior Court upholds the College of Physiotherapists’s authority over billing inaccuracies

Four physiotherapists received verbal caution over invoicing practices at their co-owned clinic

Ontario Superior Court upholds the College of Physiotherapists’s authority over billing inaccuracies

In a recent decision, the Ontario Superior Court of Justice has affirmed the College of Physiotherapists of Ontario's authority to regulate and enforce standards within the physiotherapy profession, particularly concerning billing practices.

In Spirou v. College of Physiotherapists of Ontario, 2024 ONSC 964, the court dismissed an application for judicial review by four physiotherapists, John Spirou, Praveen Oommen, Thevendri Sabga, and Chun Yeung, challenging decisions by the College of Physiotherapists of Ontario's Inquiries, Complaints and Reports Committee (ICRC). The decisions, released on April 3, 2023, required the physiotherapists to attend a panel to receive verbal caution over invoicing practices at their co-owned multidisciplinary health clinic. The physiotherapists argued that the Committee exceeded its jurisdiction and acted unreasonably in its decisions.

However, the Ontario Superior Court of Justice, adhering to the Judicial Review Procedure Act, found the ICRC's decisions reasonable and within its statutory jurisdiction, consequently dismissing the application. The court noted that physiotherapy in Ontario operates under a self-regulated model governed by the Regulated Health Professions Act, 1991, and the Physiotherapy Act, 1991. The College is tasked with regulating the profession's practice, including establishing standards of ethics and promoting relations between the College, its members, and the public.

The issue arose from the Centres for Active Rehabilitation Excellence Institute (CARE), co-owned by the applicants, and its practice of waiving insurance co-payments for services provided to Green Shield Canada (GSC) plan members. The College initiated an investigation following a complaint by GSC, which led to the discovery of CARE's billing practices. The clinic subsequently repaid GSC $42,388.96 for uncollected co-payment amounts.

The applicants contested the College's authority to regulate business practices and deemed the cautions against them unreasonable. However, the court found that the physiotherapists, as clinic owners, held a professional obligation to ensure the accuracy of billing and invoices submitted under their direction. Under its regulatory framework, the College must hold physiotherapists accountable for systemic issues in clinic practices, including billing inaccuracies.

The court further detailed that the ICRC's decisions were rooted in a factual foundation and reasoned analysis, addressing the core issues raised by the applicants. The court found that a caution is a reasonable measure to address the inaccuracies in billing and the potential impact on patients and the profession's integrity. Insurers' trust, access to benefits-covered care, and the risk of negative consequences for patients and physiotherapists underscored the necessity of caution.

The court ultimately dismissed the application, emphasizing the importance of regulatory oversight in maintaining Ontario's ethical and professional standards of health services. The Court ordered the applicants to pay $10,000 in costs to the College.

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