Medical Inspectors and Audit Hearing Panel Member Required

The Audit and Inspection Committee (AIC) is currently looking for physicians to be a part of their audit team.

When the AIC orders an on-site audit, the Billing Integrity Program (BIP) will match the medical inspector with the type of practice undergoing the audit.  Having a peer physician conduct the review is in the best interest of the physician undergoing the audit and inspection.

Once an audit is complete, the MSC may seek recovery.  If the parties are unable to negotiate a settlement or come to a resolution of the issue, the case will proceed to hearing before the Audit Hearing Panel. The Panel consists of three or more delegates, one of which is a peer physician.

There are several specialties in which medical inspectors and audit hearing panel members are required.

Medical Inspectors Required:

The Audit and Inspection Committee is looking for candidates for the following specialties:

1. Cardiology
2. Clinical Immunology and Allergy
3. Emergency Medicine
4. General Practice
5. General Practice with Hospital Experience
6. General Practice with Surgical Assist Experience
7. General Practitioner who has experience with methadone treatment of opioid dependence and is or has recently (within 3 years) been authorized to prescribe methadone
8. Internal Medicine
9. Ophthalmology
10. Orthopaedic Surgery
11. Physical Medicine and Rehabilitation
12. Plastic Surgery

*A Resume/CV is required for all candidates.

Inspectors appointed under the Medicare Protection Act inspect medical records to assess compliance with the Payment Schedule, the Act and the Regulations.  Inspectors are appointed by the Audit and Inspection Committee.

Conditions of Appointment

Candidates must:

• have a minimum of five years’ experience in the applicable specialty
• be an active registrant with the College of Physicians and Surgeons of BC
• have practices which fall within the accepted standards of the profession or generally designated by the Patterns of Practice Committee (POPC)
• be supportive of the policies and principles of the POPC and licensing body
• have the ability to exercise sound judgment
• have an understanding and knowledge of the MSC payment schedule
• not be subject to circumstances which could give rise to a conflict or interest

Inspectors are required to:

• sign a three year contract, with possible extension, with the Ministry of Health
• attend an orientation and training session
• maintain confidentiality and independence at all times as required by section 49 of the Act
• work as part of a team while on-site
• attend on-site audit, which may include travel and stay at accommodations outside the Medical Inspector’s city (length varies from three to five days)
• inspect medical records, make determinations about compliance with the Payment Schedule, and flag any quality of care concerns
• have an “exit interview” with the Auditee to clear any unanswered questions or to obtain explanations of billing issues
• review and sign final audit reports
• act as a witness before a panel established under the Act, if necessary

Compensation:

• Medical Inspectors will be paid an hourly rate derived from the hourly equivalent of the Doctors of BC’s sessional rate for GP’s or Specialists
• Inspectors will also receive compensation for eligible travel expenses

Audit Hearing Panel Member:

The AIC is currently looking for audit hearing panel members for the following specialties:

1. Obstetrics & Gynecology

*A Resume/CV is required for all candidates.

The Commission may establish a panel to make a determination under section 36(2) of the Act. The “Audit Hearing Panel” is a quasi-judicial body with the authority to hear evidence from the parties, and to make appropriate orders under the Act which may include an order requiring a practitioner to repay MSP payments to the Commission. The “Audit Hearing Panel” consists of three members – a practitioner of the same specialty as the Auditee, a Government representative (who acts as the Chair) and a beneficiary representative. Panelists are appointed by the Commission. Hearings are governed by the rules of natural justice to ensure that the process is fair. Panelists are under a duty to adjudicate fairly, effectively, and completely.

Conditions of Appointment for Practitioners 

Candidates must:

• have a minimum of five years’ experience in the applicable specialty
• be an active registrant with the College of Physicians and Surgeons of BC
• have practices which fall within the accepted standards of the profession or generally designated by the Patterns of Practice Committee (POPC)
• be supportive of the policies and principles of the POPC and licensing body
• have the ability to exercise sound judgment
• have the ability to interview people and make judicious decisions
• have an understanding and knowledge of the fee-for-service payment policies and the MSC payment schedule
• not provide any services to any person in circumstances which, in the Province’s reasonable opinion, could give rise to a conflict or interest

Panel Members are required to:

• sign a three year contract, with possible extension, with the Ministry of Health
• maintain confidentiality at all times
• work as part of a team while on-site
• attend hearings for one to two weeks, generally located in Victoria and Vancouver
• travel and stay at accommodations
• attend and participate in post-hearing deliberations to review the evidence and render a decision
• prepare and sign any relevant order

Compensation:

• Panelists will be paid an hourly rate derived from the hourly equivalent of the Doctors of BC’s sessional rate for GP’s or Specialists
• Panelists will also receive compensation for eligible travel expenses

If you are interested in any of these positions, please contact:

Juanita Grant
Audit and Billing Advisor 
Physician & External Affairs
604 638 2829
or email at View Email Addressjgrant@doctorsofbc.ca