Purpose of a billing audit
Billing audits are carried out on behalf of the Medical Services Commission (MSC) to provide assurance to BC taxpayers and government that MSP-funded medical services are managed appropriately. Specifically, the billing patterns and practices of medical and health care practitioners are reviewed to determine if services billed to MSP have been delivered and billed correctly, as well as to ensure that MSP beneficiaries are not billed for services in contravention of the Medical Protection Act.
Who is authorized to carry out MSC billing audits?
The Medicare Protection Act provides the Medical Services Commission (MSC) with the legislated authority to audit physicians. The Audit and Inspection Committee (AIC) is responsible for the auditing and inspection of the practices of medical practitioners and has been delegated the powers and duties of the MSC under the Act.
The Patterns of Practice Committee (POPC) acts in an advisory capacity to the MSC. On behalf of the MSC, the committee reviews, informs, and educates physicians regarding their pattern of practice and billings. All POPC funding costs are shared 50:50 between the MSC and Doctors of BC.
More details on the audit process
Download The Audit Process pdf, including full notes on each phase and step.
Billing audit FAQs
Why me?
An audit may be initiated based on concerns resulting from any one or more of the following:
- Complaints, either from a member of the public or a colleague (another practitioner, MOA, or allied health professional)
- Concerns by the Medical Services Plan about billing patterns
- Results of a Service Verification Audit
- Anomalies within the Practitioner Profile and Mini Practice Profiles which are not readily explainable; and/or
- Anomalies found upon review of billings or review of a sample of records
Before an onsite audit occurs, it must be approved by the Audit and Inspection Committee (AIC) of the Medical Services Commission which consists of four members:
- A member of the public.
- A physician member representing Doctors of BC.
- A physician member representing the College of Physicians and Surgeons of BC.
- A physician member representing the government of BC.
How long will the audit take?
The usual time frame for the onsite portion of the audit is 4-5 days.
Is a billing audit a legal matter?
Yes. Therefore, it is recommended the auditee contact the Canadian Medical Protective Association (CMPA) as soon as possible. The CMPA will provide an auditee with legal representation and will advocate on their behalf throughout the audit process.
Does the medical inspector look at all my medical charts?
No. On the first day of the audit, the medical inspector will ask the practitioner to provide a random sample of patients’ records (usually 60-100 patient records, but this varies depending on the type and size of practice). The medical inspector will look at all documentation within the charts of the random sample over the entire audit period, not just the areas of concern which may have initiated the audit.
Do I have to close my practice during the on-site audit?
No. You need to provide a quiet room away from patients where the medical inspector and auditor can work. You may want to assign an MOA to help to retrieve medical records and anything else the audit team needs.
Do I need a lawyer present during the on-site audit?
If a practitioner wants a lawyer present, then the Medical Services Commission does not normally object. The lawyer attends as an observer only. If you do want a lawyer present, it would be appropriate to do so at the exit interview stage when the medical inspector and auditor discuss their preliminary findings with you.
When do I find out the results of the audit?
The Medical Inspector and the Auditor will schedule an exit interview with you to go over, in general terms, the preliminary findings of the audit. After inspection of the records is completed and the audit results have been reviewed, you will receive a copy of the Audit Report and the final error list.
Will my name be published?
The identity of the individual practitioner is kept confidential except in specific circumstances. Publication may be part of a settlement agreement, or if the matter goes on to an Audit Hearing Panel, then your name would become public as the Audit Hearing is open to the public.
What supports can Doctors of BC provide during a billing audit?
Doctors of BC’s support is limited during the active phases of a billing audit. We cannot provide individual legal advice to physicians. We can help an auditee navigate the audit process and review the pre- and post-audit supports available.
For more details, review our information sheet.