For several months, we, at The Canadian, have been documenting complaints against Dr. Jerry Tenenbaum which subvert the integrity of OHIP specifically and Canada’s public healthcare system in general. On 30 December 2016, the Toronto Star further documented how the province’s 12 top-billing doctors — who received payments of between $2 million and $7 million in one year — are overcharging the Ontario Health Insurance Plan.
A Health Ministry audit into the billing practices by some doctors uncovered significant “concerns” about their claims to the taxpayer-funded plan. Patient complaints against Dr. Jerry Tenenbaum which have been published by RateMDS and other sites online further corroborate such concerns.
According to the documents, six allegedly charged for “services not rendered,” five “upcoded” or billed OHIP using fee codes for more expensive procedures, and three charged for “medically unnecessary” services, which the plan is not designed to fund, the probe found.
For two years, Dr. Jerry Tenenbaum ordered very expensive tests on one patient promising treatment which never came. This patient suffered through Dr Tenenbaum’s tests including an MRI. After 2 years Dr Tenenbaum only prescribed bottles and bottles Tylenol. Having used up precious public medical resources, this is a clear apparent abuse of taxpayer resources.
The analysis shows the doctors, all specialists, billed an average of $4 million in fee-for-service claims between April 2014 and March 2015.
The top biller cited by the Toronto Star was an ophthalmologist who received $7 million. Health Minister Eric Hoskins said in April that this physician was paid $6.6 million, but the analysis shows an updated number. (Payments are not the same as income, as they do not take into account expenses for office rent, staff salaries and supplies.)
The remaining top billers documented by the Toronto Star include two additional ophthalmologists, three obstetrician/gynecologists, two diagnostic radiologists, two cardiologists, one anesthesiologist and one internal medicine practitioner. The names of the specialists are kept secret in the report, which the Star obtained through a freedom of information request.
The Star has been trying since April 2014 to have the names of the highest billers released. Earlier this year, the province’s privacy commissioner ruled in favour of an appeal by the Star, but three groups of doctors, including the Ontario Medical Association, are seeking to have that decision overturned. The case is headed to Divisional Court next year.
It would be in the public interest if such abusers of the system were revealed.
As documented by The Canadian, the socially irresponsible behaviours of doctors like Jerry Tenenbaum not only exploit our taxpayer-funded and government-supported system, such doctors also threaten the well being of the patients they exploit and other patients who are being deprived of access to medical resources because certain doctors are abusing the system.
The ministry began its audit of the dozen top billers in late 2015 as part of a plan that calls for “better patient care through better value from our health-care dollars,” the report states.
A team of reviewers writes the Star, which included three medical advisers and five external medical specialists, spent more than 3,000 hours analyzing more than 6,000 records, images andreports related to the “unique and highly complex” practices of the top billers, it says.
Among additional “concerns” alleged in the report:
- Three specialists “inappropriately delegated” duties — for which they billed OHIP and which were supposed to perform themselves — to unqualified individuals to undertake.
- Six claimed to have worked between 356 and 364 days of the year.
- Eight recorded notably high volumes of claims and/or patients. One radiologist, who worked 332 days, billed for 100,000 patients, indicating that more than 300 scans were interpreted per day, the report stated.
- Eleven billed OHIP incorrectly.
- An obstetrician/gynecologist billed for seeing male patients.
It’s unclear from the report what the province is doing about the findings.
Part of the report, entitled “Recommended Action(s) and Next Steps,” was censored. Options given include: request repayment, fraud referral to the OPP, education, referral to the College of Physicians and Surgeons of Ontario, which regulates doctors, and referral to the Physician Payment Review Board, which holds hearings to resolve billing disputes.
A Health Ministry source, speaking on the condition of anonymity because they were not authorized to speak about the audit, said some of the cases have been referred to the college.
Hoskins was not available to comment on the report.
In an emailed statement, Dr. Virginia Walley, president of the Ontario Medical Association, which represents the province’s 30,200 doctors, said:
“The assumption that any physician has done something wrong before a formal process has been completed is detrimental and unfair. It is essential that all physicians have access to a just process.”
Walley referred to the organization’s turbulent relationship with the province. For close to three years, the two sides have been at odds, unable to negotiate a new physician services agreement. In the absence of one, physicians have no formal forum to discuss issues like this, Walley said.
“In an environment where Ontario’s doctors continue to be vilified by the provincial government, it is easy to jump to conclusions when looking at complex billing data. However, without all of the details about an individual physician’s practice, premature conclusions would be irresponsible,” she said.
However, it is apparent that the OMA is simply trying to support a cover-up.
As a result of the activities of Dr. Jerry Tenenbaum, a once super strong woman can no longer write, walk or talk. There have been numerous patient complaints against Dr. Tenenbaum. In response to an investigation by the Ontario College of Physicians and Surgeons against Dr. Tenenbaum, there appears to be a recent effort to hire people to write 5-star reviews on Dr. Jerry Tenenbaum who has lied the the Ontario College of Physicians and Surgeons about his relationship to at least one patient.
Provincial auditor general Bonnie Lysyk made reference to the analysis of the top billers in her annual report released in November.
“The ministry suspected that some of these billings might have been inappropriate,” she wrote.
Lysyk said that two of the outliers, an ophthalmologist and a cardiologist, provided an extremely high number of diagnostic tests. She followed that up by saying a national campaign called Choosing Wisely discourages “unnecessary” diagnostic tests and treatments.
These procedures, which are not supported by scientific evidence, can expose patients to harm, lead to more testing to investigate false positives, and contribute to patient stress, according to the Choosing Wisely campaign. As well, they put increased strain on the limited resources of the health-care system.
Lysyk urged the province to improve oversight of fee-for-service payments and to pay particular attention to “anomalies and outliers.” She recommended that the Health Ministry re-establish an “inspector function” to oversee billings.
The province has had no inspector function since 2005, when it disbanded its Medical Review Committee. That move was made on the recommendation of retired Supreme Court justice Peter Cory, who reviewed the committee’s auditing process and found it to be “debilitating and devastating” to physicians. His review followed the suicide of a pediatrician who had been audited.
The auditor general’s report said the ministry has challenges in managing and controlling the use of services billed under the fee-for-service system.
Fee-for-service claims are paid to physicians based on an honour system. Doctors are compensated based on a standard fee for each service performed, using fee codes from OHIP’s Schedule of Benefits.
“The Schedule of Benefits could be providing some physicians with an incentive to schedule patient visits and perform medical services strategically in a way that maximizes their billings,” Lysyk wrote.
Fee-for-service favours “procedural” specialists — those who perform procedures such as diagnostic testing and surgery — and those who generate high volumes of services, she noted.
Here are some examples of patient reviews on Dr. Jerry Tenenbaum:
One patient in Toronto commented that ,“During my last visit to this doctor, I feel that he rushed things up. I thought the doctor would have discussed about the treatment with me a little bit longer but he did not. My meeting with him only did not even last for about 5 minutes before I went out of his office. I thought also he would have showed interest but he did not. I wouldn’t recommend this doctor to anyone.”
Yet another patient specifically made one rather long comment about his apparent “Drive Thru” practice on 15 October 2014 (unedited representation):
“This Dr. is useless. He is always in a a rush ( I am not sure why his office is almost empty when I go). I explained to him that my lymph nodes are swollen he tells me to get my family dr. to make a referral for a neck ultrasound…why can’t he make the referral?. Now I have to go to my family dr to make an appointment (waste of the health care system). Then once the ultrasound is done I have to go back the family dr. to get a copy of the report (which is important because the technician said to me my lymph nodes are on the larger side of normal so I have to worry about lymphoma and should get ultrasounds once per year to monitor) but of course the hospital forgets to send the report to the family dr. My point here, he should be dealing with this, it is because of my sojgerns syndrome that I needed the tests in the first place. Now he doesn’t even know that I should get the tests done once per year-because the lab report is somewhere in the wind but even if he did know he would probably make me go to the family dr. to make the referral every year ugh) When my endocrinologist wants a test done she makes the referral and so should my rheumatologist. He did initially diagnose my condition but any rheumatologist can order blood work and read the lab results all in all, he treats his practice like a McDonalds drive through and he is pretty useless.”
Another patient in Toronto similarly posts that, ”This doctor is very rude and arrogant. It seems like he’s more concerned with getting you out of his office as fast as he can. Barely makes eye contact and truly lacks any remorse for your condition. This is my person opinion based on my experience with Dr. Tenenbaum.”
In Victoria, another patient documents “In my opinion, one of the worst specialist I have ever had to deal with. Every time I had an appointment there at his clinic, I could hear him tell all the patients the same thing “Exercise, loose weight, etc.” When I went to him desperate to get answers, he was rude, insulted me and gave me the same answers I could hear him give all the other patients. Told me I was fat, lazy, and need more exercise. He was wrong. I found another specialist who has been great at helping me have a better quality of life without pain pills. I am also suspicious a lot of these comments on here with 5 stars are fake, probably his staff or the Dr. himself????? I am suspicious Dr. Tenenbaum is just running an MSP paper-billing-machine. I am suspicious Dr. Tenenbaum is abusing MSP billing, and acting incompetent in his level of expertise, that he claims he has.”
Indeed, could Dr. Tenenbaum himself be responsible for the apparent 5-star reviews that were all of a sudden published about him only after the Ontario College of Physicians and Surgeons began to investigate him?
Here’s another review by a “satisfied” patient in Victoria:
“This is the one doctor I wish I had never seen. He originally gave me a dx back in 06, but failed to help me manage said dx. He chalked it up to me being overweight (he wasn’t exactly a healthy weight, either!) and, even after losing all of my excess weight and doing a total lifestyle overhaul, I am still in constant pain. He didn’t do anything to help me manage the pain levels. He only suggested I ‘get more sleep’ but refused to help me with that. As somebody that still struggles with chronic insomnia, getting ‘more sleep’ isn’t always attainable! Thankfully, I have since found somebody with considerably more empathy, who has actually helped me with my pain issues. 8 years after dealing with this “doctor” and I’m finally seeing some progress!”
India’s VIP culture: Forget Lincoln’s definition of democracy. India’s government is of VIPs, by VIPs and for VIPs
Last week, the Madras high court ordered the National Highways Authority of India to separate ordinary citizens from VIPs at toll gates, with a dedicated lane for the latter. Of course, high court judges are included in the list of VIPs. The court held it to be ‘disheartening’ and ‘very unfortunate’ that judges are ‘compelled to wait in the toll plaza for 10 to 15 minutes’.
NHAI decided to challenge the directive. One might have expected the judges to be rather more concerned that more than a million cases have been pending in 24 high courts across India for over a decade. According to CJI Dipak Misra, the total backlog of cases at all levels of the judiciary is a staggering 33 million! The impact of this delay should weigh a bit more heavily in the minds of the learned judges while they leave matters of administration in the hands of the executive branch of government.
What is telling about the directive is the VIP mentality that has become part of the DNA of India’s ruling elite. Contrary to Abraham Lincoln’s famous definition of democracy, India has a government of VIPs, by VIPs and for VIPs. They do what they can, the people suffer what they must. In the heyday of European empires, colonial masters ruled imperiously over conquered subjects. During the Raj, the British class system fused seamlessly with India’s caste system to entrench social divisions even more rigidly.
After independence, India proudly declared itself a sovereign democratic republic and added the word ‘socialist’ in the Constitution. The central tenet of the four words taken together – sovereign, democratic, socialist, republic – is the sovereignty of the people. Politicians and officials are their servants. But as in other self-described socialist and communist paradises, India’s ruling elites captured all the privileges while the disempowered populace was saddled with poverty, scarcity and general misery.
The elite moved into the newly-vacated opulent bungalows of Lutyens’ New Delhi, even as the growing mass of destitute citizens lived in slums that sprang up along the city’s outskirts. Gradually political office became the fastest route to miraculous wealth acquisition and conspicuous consumption. In time the brazenness of privileged behaviour spread to an all-encompassing sense of entitlement as the political and bureaucratic elite, in that order, began to act like feudal overlords over citizens.
The more that the quality of public services (health, education, infrastructure) decayed and institutions were degraded and corrupted, the greater was the distance between the lifestyle of the closed circle of the elite and ordinary citizens. Inevitably this morphed into the VIP culture that Indians by and large detest with a depth of contempt, anger and resentment that is difficult for foreigners to fathom.
The Congress party bears particular responsibility for this sorry state of affairs as the party of government in New Delhi and most states after independence. One of the great attractions of Prime Minister Narendra Modi’s election winning slogan of good governance in 2014 was it promised to restore the rightful balance in relations between citizens, officials and politicians. ‘Twas not to be. In this as in most other respects, the gap between boastful rhetoric and actual practice remains distressingly wide: the 56-inch chest has been overshadowed by a 96-inch tongue.
Modi has tried to lead by example in some respects and is not in the least bit ostentatious himself. Nor has he given any indication so far of abusing his office for private gain or mistreating citizens. But this was the defence that his predecessor Manmohan Singh adopted without success: that the sea of corruption in which so many of his ministers were drowning was no indictment of his performance, for he himself was squeaky clean.
Similarly, although Modi himself has not been seduced by the VIP culture, he has failed to assert himself against those from within his and allied parties who have very publicly abused their offices. Perhaps he did learn the trick of bathing with a raincoat from Dr Saheb after all.
An obvious display of VIP culture that strikes foreign visitors is the list, in full public display at airports, of more than 30 categories of VIPs exempt from pre-boarding security screening. And how else other than a deeply instilled VIP culture do we explain Shiv Sena’s MP Ravindra Gaikwad’s air rage last year when he boasted he’d used his slippers to hit a 60-year old Air India staffer 25 times?
In a civilised country Gaikwad would have been expelled from the party, charged with assault and lost his seat. The party would have moved quickly to apologise to the attendant and the people and promised that such appallingly thuggish behaviour is neither condoned by nor acceptable to the party. But not in India’s corrupted political culture. Instead, Shiv Sena threatened to disrupt air travel. The Centre capitulated to this mobster-like blackmail and ordered Air India to take Gaikwad off the no-fly-list. Throughout the highly publicised episode, Modi’s silence was as eloquent as his predecessor’s on maha-scandals.
Compare this to a notorious incident in Pakistan – supposedly a less robust democracy – where on 15 September 2014, former interior minister Rehman Malik held up a plane for two hours. When he finally boarded, angry passengers harangued him and refused to let the plane take off until he had been thrown off. A passenger uploaded a video of the incident to YouTube. Two weeks later he was sacked from his unrelated job but not before his video was widely shared and praised by a public sick to death of Pakistan’s VIP culture.
Priyanka Gandhi’s entry into UP politics has sent political opponents into tizzy
Conventional political wisdom, in the absence of credible caste Census data, classifies 52 per cent of the state’s population as ‘Backward Classes’, 18 per cent as Dalits, 5 per cent each of Brahmins and Thakurs and Muslims as 17 per cent of the people. Smaller castes and sub castes are said to constitute the remaining three per cent.
The caste cauldron of eastern Uttar Pradesh has witnessed Kurmis float the ‘Apna Dal’ and the Rajbhars forming the Bharat Samaj Party. Boatmen and fishermen in eastern UP also are clamouring for better representation in politics. They will want their pound of flesh and bargain hard for seats. The small parties have small pockets of influence but are said to be important. Some say they are more important in 2019 than they were in 2014. Can they win half a dozen seats on their own or play the spoiler and, if so, for whom?
Eastern Uttar Pradesh took an active part in the freedom struggle and has been a hot bed of politics for long. With the passage of time, people have become politically aware and have responded to leaders like Ram Manohar Lohia and Chaudhary Charan Singh in the past.
“But as you can imagine, this is a snakepit,” quips a regional Congress leader. “It is going to be an uphill task for Priyanka Ji. She has very little time, less than two months, before the general election and it would certainly require a Herculean effort on her part,” he quips.
But that she means business became evident in less than 48 hours of her arrival in Lucknow, when she, flanked by the general secretary in charge of western UP Jyotiraditya Scindia and Keshav Deo Maurya of Mahan Dal, announced a poll alliance with the small party active in western UP.
“I welcome Keshav Maurya ji. We will fight the elections jointly. Rahul ji has given us the task of creating a political atmosphere in which everyone is taken along and all sections of the society are represented,” Priyanka said. “We will contest with full might,” she asserted.
Predictably, the Bharatiya Janata Party, which desperately wants to ensure that it does not lose too many of the 71 constituencies it won in 2014, has reacted with disdain in public. But its growing concern at Priyanka Gandhi Vadra catching eyeballs, time and space in the media, especially Television, is manifest in even casual conversations.
“Television has been Modi Ji’s turf and we have milked it for the past five years and more. But suddenly TV channels are devoting considerable time following Priyanka Gandhi Vadra and discussing the impact she may have,” admitted an old BJP hand. While the BJP has largely bought media space, he grudgingly conceded that the Congress was receiving ‘ free publicity’ ever since it was announced that Priyanka Gandhi Vadra would formally hold charge of eastern UP.
The party is divided on how to counter the threat posed by her. While knives are clearly being sharpened to launch vicious attacks as and when she starts moving out and address public meetings, there are doubts that the move might boomerang and fail to yield much political dividend.
Ignoring her is another option that has been discussed, confide BJP insiders. But the thinking is to evolve a strategy as and when she slips. BJP leaders believe that while she possibly has a better command over Hindi, she eventually may not prove to be much of an orator.
“Election rallies require rousing speeches, sharp barbs, an ability to get the crowd to laugh and rage – and there is no match for Narendra Modi,” says a BJP leader with satisfaction, convinced that Priyanka Gandhi Vadra is far too polished to make much of a difference on public platforms.
Another BJP strategy is to belittle her experience and performance in the pocket boroughs of the Congress in Amethi and Rae Bareli. “How many Assembly seats could she win for the Congress,” is what BJP workers have been advised to ask in public in an attempt to play down her impact.
But the worry shows and notwithstanding their stance in public, on Monday Chief Minister Yogi Adityanath abandoned a review meeting with district magistrates to huddle with senior party leaders following the six-hour road show in Lucknow by Priyanka Gandhi Vadra.
Says Alok Kumar Rai of the Faculty of Management Studies at BHU (Varanasi), “The strategy of playing down Priyanka Gandhi may actually have the opposite effect.” The attack on the dynasty, say observers, is stale and weak and the other approach, of saying that Priyanka Gandhi Vadra has been inducted to cover up the failure of her brother, may actually enhance her public stature.
By all reckoning, Priyanka Gandhi Vadra’s entry into UP politics seems to have upset all political applecarts, at least for now. Keshav Dev Maurya of Mahan Dal (right), a small party in western Uttar Pradesh, announced on Wednesday that it would contest the election in alliance with the Indian National Congress. He is seen in this picture with Jyotiradiya Scindia ( left) and Priyanka Gandhi Vadra
Partners again: Pragmatic compulsions push BJP into making up with estranged ally Shiv Sena
The seat sharing deal between BJP and Shiv Sena ends over four years of public bickering between old allies, stemming from BJP’s unwillingness to settle for junior partner status in the 2014 Maharashtra assembly polls. Both parties fought separately and BJP came on top winning 122 seats against Shiv Sena’s 63. Later, Sena joined the state government but its resentment at not being the dominant partner showed, as it continued hurling barbs at BJP.
Sena’s barbs would have hurt BJP more than the opposition’s because both parties’ bases overlap significantly. Yet both needed each other and this kept the alliance in place. The seat sharing deal with Sena is an acknowledgment by BJP that the downside risks of fighting Lok Sabha elections without its ally-cum-foe are too forbidding to ignore. A similar situation forced BJP to part with 17 seats for JD(U) in Bihar. In making peace with former critics like Uddhav Thackeray and Bihar chief minister Nitish Kumar, BJP appears to have concluded that 2019 is too close to call.
Anti-incumbency and the newfound resolve among opposition parties to prevent division of their vote could be behind BJP’s mellowing, as it shores up alliances through generous seat sharing arrangements. In Maharashtra, Congress and NCP are reviving their alliance and reportedly wooing smaller parties led by Prakash Ambedkar, Raju Shetti and Raj Thackeray. Recall that the Congress-NCP alliance won three successive assembly elections before being felled by the Modi wave of 2014. BJP may rue the surrender of gains it made vis-a-vis the Sena in Maharashtra but coalition arithmetic demands such sacrifices.
In the 1990s it was BJP that propped up Nitish after his split with Lalu Prasad. The investment paid handsome dividends when the JD(U)-BJP coalition stormed to power in Bihar in 2005. In 2017, when JD(U) was again on a weak wicket, BJP played a masterstroke to woo it back. As a result, NDA may fare better in Bihar after the lashing in the 2015 assembly polls. BJP president Amit Shah had preferred a maximalist approach to politics earlier, but that is taking a backseat now due to pragmatic compulsions. Recall that the north-east was also won through alliances. Both BJP and Shiv Sena have an opportunity to put the past behind them. But selling the alliance to voters after Sena’s incessant criticism will be a tricky proposition.
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