Regretfully, health care fraud runs rampant throughout the United States. This isn’t to say that submissions of bogus billings, for example, are exclusive to American health practitioners. Our neighbors to the north have endured their fair share of fraudsters as well. A big news story coming out of Canada this week reveals that the province of Alberta has recently seen its largest billing fraud case in history.
As reported by Janice Johnston of CBC News, Dr. Yifei Shi billed Alberta Health for a total of $1,388,862 in 2016. The Edmonton-based physician admitted in court that $827,077 of that amount was fraudulent. The false billings were for non-existent psychiatric counselling and treatment for hundreds of patients.
Dr. Shi was arrested in April 2021.
Edmonton police charged the 35 year-old with one count of fraud over $5,000 and another count of theft over $5,000. According to court documents, Shi billed for psychiatric counseling on almost every patient she saw. However, she did not provide psychiatric treatment to her patients in the amounts that she claimed to Alberta Health. Last Thursday, she pleaded guilty to the fraud charge.
Edmonton police, however, believe that Shi is guilty of far more fraud than she admitted to. Johnston reports that the doctor is alleged to have overbilled the Alberta government upwards of $4.1 million since 2013. Interestingly, Shi continued to practice medicine at West Edmonton’s Commerce Park Medical Clinic after being charged. However, all of the money she claimed through billings was held in escrow by Alberta Health. They amounted to $582,000 in effective compensation to the provincial government.
Shi’s lawyer contends that she truly cares for her patients.
In spite of her guilty plea, Shi maintains that she has her patients’ best interests at heart. Her lawyer, Kent Teskey told the court that the family doctor dipped into her own savings to pay for office overhead and staffing costs after she was charged. He also insists that Shi is remorseful. The court agreed that giving up her earnings reflected that. Teskey asked the court to consider a prison sentence of 24 to 30 months.
Crown prosecutor Megan Rosborough clarified, however, that Shi’s crime was the largest billing fraud by a doctor in Alberta history. She asked the judge to impose a five-year prison sentence. “She committed fraud on a daily basis, often multiple times a day, over the course of a year,” Rosborough told the court, “The only reason she did it was greed.” In addition to her four-year prison term, Shi must also pay back $827,077 in full restitution.
Shi’s patients are shocked.
Jonny Wakefield of the Edmonton Journal reports that Shi’s patients are “picking up the pieces”. Looking for new family doctors, which appear to be in short supply, is just one stress they are enduring. Having to potentially change medications and treatment plans is another. One patient even found that requisitions written by Shi a month ago were no longer being accepted.
“(I have) a lot of mixed emotions,” said former patient, Bobbi Fry, “I was afraid for what my medical future was going to look like, having to now start all over again. I was mad at Dr. Shi, because I felt like she could have easily had a growing practice and made all of this money on her own without stealing it.”
Are you an attorney working on a fraud case?
Allegiant Experts is your authority on healthcare coding, billing and reimbursement. Contact us today to schedule a complimentary consultation. Give us a call at 407-217-5831 or email us at firstname.lastname@example.org.