She helped thousands get COVID-19 shots. Now she's on the hook for $600K

UPDATE | On Nov. 26, 2024, the Health Services Appeal and Review Board found Ma did not follow the rules and ordered her to reimburse OHIP $600,962.16 plus interest.

A Kingston, Ont., doctor celebrated for organizing drive-thru vaccination clinics that helped thousands get shots at the height of the COVID-19 pandemic is now being ordered to pay back more than $600,000 in fees for those same services.

Dr. Elaine Ma said she organized 45 mass vaccination clinics that administered roughly 35,000 doses between April 2021 and the following February.

Her work was recognized by the Ontario College of Family Physicians, which granted her its Award of Excellence in 2021, in part pointing to Ma's role in boosting local vaccination rates.

About a year later, the doctor said she received notice from the Ontario Health Insurance Plan (OHIP) seeking to recoup the money she had billed for the shots — approximately $600,000, plus around $35,000 in interest.

"I was shocked that OHIP chose to do this and chose to not look at the big picture here, which is, we saved lives," said Ma, adding that although only a few years have passed, people already seem to be forgetting what life was like amid the first waves of COVID-19.

Answering the 'call to arms'

At the time, Premier Doug Ford and retired general Rick Hillier, who was overseeing Ontario's vaccine rollout, were urging people to get their shots, Ma recalled.

"We answered the call to arms. We did it on good faith. We did it because people would end up in ICUs — or worse, dead — if they weren't vaccinated," said Ma, whose story was first reported by local news outlet Kingstonist.

It's a situation the president of the Ontario Medical Association said rewards a "heroic effort" with rigid bureaucracy. Kingston's medical officer of health believes it could have a "catastrophic" chilling effect on ingenuity the next time the province asks physicians for help responding to an emergency.

No one is disputing that Ma set up the clinics and doled out tens of thousands of doses, but the doctor said OHIP is arguing she was not allowed to delegate tasks outside the four walls of her office without written approval, based on a bulletin issued 20 years earlier.

A copy of the document, obtained by Radio-Canada, also states that as of April 2001, the person carrying out a procedure must be an employee.

That means the use of medical students from Queen's University to provide inoculations was a "misuse of the billing code" Ma relied on, according to a spokesperson for Ontario Health Minister Sylvia Jones.

Ministry investigating claim doctor 'pocketed' funds

In a statement to CBC, Hannah Jensen wrote that during the COVID-19 pandemic, a ministerial order was issued offering an hourly rate for all insured services at assessment centres, including vaccinations.

Doctors could also bill existing fees for vaccines given in their offices if they or their staff administered the shots, but if that order wasn't followed correctly, physicians would need to return the fees they "improperly" collected, she stated.

"No other doctor in the province who ran a mass vaccination clinic is having this issue," Jensen wrote in an email, when asked about the situation faced by Ma.

"This doctor billed the Ministry for over 23,000 vaccines over 5 days, incorrectly billing the Ministry for $630,000, 21 times their eligible payments."

Jensen said the ministry is also investigating a claim that Ma paid volunteers "20% of the total claim and pocketed the remaining amount." However, the ministry would not provide further details about the allegation.

Ma said she used the same billing code she'd used in the past for vaccinations such as the flu shot. And while OHIP seems focused on the five or six busiest clinics she led, the amount she's being asked to repay accumulated during dozens of others, according to the doctor.

She also said OHIP is ignoring the days of work before and after each clinic, including training medical students, drawing up thousands of vaccines and making sure they were tracked in a provincial database.

"They're saying, 'Ooh, one doctor shouldn't make money, or not to that extent,'" said Ma, who pointed out similar mass-vaccination clinics carried out by pharmacies or public health units have escaped similar claims.

While the money she's being asked to repay is a worry, Ma said she's more concerned about the principle of punishing a doctor who did her part to help during a crisis, and the limits that could be placed on training for medical students.

"Doctors are now afraid of being targeted by OHIP for doing what is the right thing, which is helping our patients," she explained.

Ma described the tone of the ministry's statement as "accusatory," adding the only investigation she's aware of is the OHIP dispute, which resulted in her spending the past two weeks at a hearing before the Health Services Appeal and Review Board in Toronto.

"It's very disheartening and discouraging to hear that that's what the Ministry of Health thinks of me," she said.

Doctor's efforts were 'heroic'

It also stands in stark contrast to the praise from Ma's medical colleagues.

Dr. Dominik Nowak, president of the Ontario Medical Association, called Ma's efforts during the pandemic "heroic."

"This is an example of a doctor that should be celebrated, rather than having barriers and clawbacks and a bureaucracy that's unnecessarily rigid," he said. 

Nowak described OHIP's apparent "hunt" for a reason to recover money from a physician who tried to lend a hand during the pandemic as a "breach of trust."

Dr. Piotr Oglaza, medical officer of health for Kingston, Frontenac and Lennox & Addington Public Health, said Ma's clinics had the full support of his organization. He even participated as a volunteer.

He wrote a letter to the board on her behalf urging it to consider the context in which her clinics were held, and crediting the drive-thru model with relieving pressure on the public health system by providing roughly seven per cent of all doses administered in the region.

Oglaza said neither he nor Ma were aware of the OHIP bulletin she's now accused on contravening. Had he been, he said he would have raised it with the province and has no doubt it would have been waived, given the desperate push for vaccinations at the time.

He also warned Ma's ordeal could discourage physicians from taking on the logistics and liability of a mass vaccination project the next time Ontario faces an emergency, because they risk getting caught up in technicalities from OHIP.

"I think that that will be really, truly catastrophic," said Oglaza.