Cases Considered: Searles v. Alberta (Health and Wellness), 2008 ABQB 307
PDF Version: Money attracts procedural fairness: The case of the overbilling doctor
Government compensation payable to physicians in Alberta is differentiated under the Alberta Health Care Insurance Plan based upon the type of service provided: in short, some service categories pay better than others for physicians. In 2002 Dr. Gordon Searles received notice from Alberta Health and Wellness that his billings to the Alberta Health Care Insurance Plan were being reviewed. This review led to a reassessment under section 18 of the Alberta Health Care Insurance Act, R.S.A. 2000, c. A-20, which provides the Minister of Health and Wellness with authority to reassess physicians’ billings on select grounds including where the Minister is of the opinion that “the total amount of benefits paid for service was, in the circumstances, greater compensation to the practitioner for that service than it should have been.” In this case, the Minister’s reassessment (via her delegate) required Dr. Searles to repay $985,777.09 having concluded upon review of his billings that he was overcompensated. The reassessment was based upon the Minister’s conclusion that between April 2000 and February 2004 Dr. Searles’ billing submissions were calculated on the provision of a service category with a higher billing rate than the actual service Dr. Searles had administered to his clients. Dr. Searles subsequently applied to the Court of Queen’s Bench to have the Minister’s reassessment quashed on judicial review for procedural unfairness.