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Former Sussex doctor taking legal action after order to repay $ 500k in billings

A former New Brunswick family doctor who closed her Sussex practice in February had been ordered to repay the Department of Health more than $ 500,000 in Medicare billings.

Dr. Sunita MacMullin, who now practices in Ontario, was told she overcharged the province after a review of her fees-per-service billed between April 1, 2019 and March 31, 2021, according to court documents filed.

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

The doctor began taking legal action against the province in March after a second planned audit of her 2016-2019 billings. She is asking the court to quash the review of additional records during that time period and prohibit further reviews until an appeal on the billings repayment is addressed.

The doctor is also seeking disclosure of the province’s records related to the review of her 2016-2019 billings, according to the documents filed in 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 “on call” support from other doctors.

She had worked in both family and emergency medicine in the province since 1999, also seeing patients at a special care home, according to her affidavit.

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

In 2019, Medicare contacted her to request an audit of billings between April 1, 2016 and March 31, 2019. The doctor said she participated “without hesitation,” granting full access to officers who visited her clinic over four days. It found no discrepancies.

Audit finds lack of documentation

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

In December 2021, the Department of Health sent MacMullin a letter with an explanation of 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 common lack of supporting details and documentation for treatment plans.

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

‘I felt unwell’

On February 24, she was advised by her lawyer 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 notified MacMullin that it would be conducting a second review of 2016-19 billings.

Shortly after the repayment order, MacMullin gave notice to Horizon Health that she was quitting her Sussex practice.

“As the stress of these Medicare matters became unbearable, I felt unwell. I was no longer safely able to practice medicine in this setting,” she wrote in the affidavit.

“I take a lot of pride in my work in New Brunswick. I cared for my patients. I took my billing responsibilities seriously. If I made any billing errors, I have no objection to repaying those claims to Medicare.”

Review unreasonable, doctor says

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

She said she has repeatedly sought the province’s 2019 audit file of her billings.

Court filings include a letter from the province sent in October 2019. It said the 2016-2019 review of fee-for-service billings resulted in “no adjustment or recoveries” to claims, noting that the documentation from her office was “clear, organized and consistent in nature. “

In the application, MacMullin said the Department of Health has already reviewed the 2016-2019 period and the additional review is beyond the scope of the Medical Services Payment Act. She said the additional 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 on Nov. 17.

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