Health P.E.I. has been overpaying Ontario firm for radiology services for years, watchdog says

1 month_ago 31

PEI

Health P.E.I. has been overpaying by arsenic overmuch arsenic 100 per cent for off-hours radiology services provided done an Ontario company, according to the province’s auditor general.

'Ensuring that payer wealth is spent wisely and appropriately is simply a cardinal responsibility'

Kerry Campbell · CBC News

· Posted: Jul 16, 2025 6:00 PM EDT | Last Updated: 2 hours ago

Health P.E.I. has been overpaying by arsenic overmuch arsenic 100 per cent for off-hours radiology services provided done an Ontario company, according to the province's auditor general.

In a study released Tuesday, the bureau of Auditor General Darren Noonan said the contented has been raised with the province's wellness authorization annually since the audit of its 2021 fiscal statement, yet it still has not been addressed.

What's more, the AG's study says the azygous presumption designated wrong Health P.E.I. to audit aesculapian claims has been mostly vacant since April 2022, with nary 1 other fixed work for analyzing claims oregon recovering overpayments for erroneous billings.

No audits of doc billing person been performed successful that time.

'Taxpayers paid much than they should have'

Radiologists are doctors who construe images from X-rays, MRIs and different diagnostic images.

Health P.E.I. has an statement with a backstage institution to supply after-hours radiology services utilizing off-Island radiologists. The sanction of the institution is not included successful the AG's report.

The payments see premiums of 25 to 100 per cent, depending connected clip of day, to supply exigency service. But those services person to beryllium delivered wrong 30 minutes successful the lawsuit of a imaginable stroke, oregon wrong 60 minutes for different emergencies.

The AG's bureau analyzed a illustration of 30 after-hours radiology billings and recovered that successful astir fractional of them, premiums were paid for exigency services erstwhile they should not person been.

"In these cases, taxpayers paid much than they should person for these services," the study says.

In 1 lawsuit examined by the AG's office, a premium was paid for one-hour exigency work erstwhile the study connected the representation came backmost 36 hours aft it was sent.

Prince Edward Island's agelong hold times for MRIs are getting adjacent longer

P.E.I. residents are facing the longest hold times connected grounds for MRI scans, with the existent hold for a regular scan sitting astatine 2 years. The state says staffing levels volition instrumentality to mean successful the caller year, but that successful itself won't marque the occupation — oregon the agelong hold lists — disappear.

According to the AG's report, unit wrong Health P.E.I.'s Medicare bureau noticed immoderate radiology reports were incurring exigency premiums adjacent though the reports didn't travel backmost wrong the required timelines.

They asked whether they should wage the claims, oregon if they should commencement monitoring them much closely.

They were advised to wage them, and to "disregard whether the teleradiologist work the representation successful the required timelines."

Health P.E.I. has a argumentation successful spot that requires Medicare unit to show and retrieve immoderate identified overbillings.

The AG's bureau recovered that galore employees, including Health P.E.I.'s elder fiscal analyst, were not alert of the beingness of the policy.

In its effect to the report, Health P.E.I. said it agreed the premiums for exigency radiology services should lone beryllium paid erstwhile the required timelines are met.

A tiny gathering with a ample achromatic and greenish motion saying Health P.E.I.

The bureau said applicable policies would beryllium re-circulated to unit liable for after-hours premium payments, and predisposition and onboarding for unit liable for doc billings investigation and audit would beryllium modified to guarantee they person each the accusation indispensable for their roles.

It said this is an country wherever it has "experienced important staffing vacancies and turnover."

Looking for institution to audit billings

Health P.E.I. besides said it recognizes "the request to marque improvements to claims monitoring, compliance and betterment processes to place and close overbillings."

The bureau said it plans to present a new annual doc audit program this fall, but that depends connected uncovering an outer institution to supply that service.

A full-body MRI instrumentality operated by Prenuvo, down a machine surface showing whole-body scans of a patient.

Neither Health P.E.I. nor the auditor wide enactment a dollar magnitude connected however overmuch mightiness person been overpaid connected after-hours radiology premiums. And determination was nary effect successful clip for work from Health P.E.I. connected whether it intends to effort to recoup that money.

Noonan's study shows that fees paid to radiologists were successful the scope of $11 cardinal successful 2024, representing a $4 cardinal summation implicit the past 5 years.

Health P.E.I. paid much than $450,000 successful after-hours premiums to radiologists successful fiscal 2024.

"One of the biggest responsibilities for authorities is the stewardship of payer dollars," Noonan told CBC News.

"Ensuring that payer wealth is spent wisely and appropriately is simply a cardinal work for [Health P.E.I.]. That's the main crushed wherefore this is important."

ABOUT THE AUTHOR

Kerry Campbell is the provincial affairs newsman for CBC P.E.I., covering authorities and the provincial legislature. He tin beryllium reached at: [email protected].