In what may be one of the largest cases of doctor billing fraud in Canada’s history, Yifei Shi, a 35-year old Edmonton family doctor, was sentenced to four years in jail on Nov. 17. Shi pled guilty to fraudulently billing Alberta Health Services over $827,000 in 2016 and was ordered by Court of King’s Bench Justice Paul Belzil to repay the Alberta government in full.
An agreed statement of facts obtained by CTV News Edmonton says Shi billed for “psychiatric counselling on almost every patient that she saw” but often didn’t in fact provide those services.
She continued to work with patients at her west Edmonton general family practice after being charged, but her earnings, in the amount of $582,000, were held in escrow by Alberta Health to be paid back to the provincial government.
Shi’s lawyer, Kent Teskey, told the court his client was remorseful and had continued to work, “knowing that money would be held.” The Crown initially sought a five-year jail term. Teskey asked the court to be more lenient, with a jail term of 24 to 30 months, noting that “she’s been serving her patients. They appreciate the fact that she continued to practise.”
“She’s shown grace with this plea,” he said. “This is a very unique fraud, but it’s a very unique offender here.”
‘Greed’ Blamed for Overbilling
Crown prosecutor Megan Rosborough said in court submissions that the doctor “was a mature individual who had the privilege of employment in a job earning over $500,000 per year.”“She had every advantage in life: education, wealth and a great job. She used all of these advantages to perpetrate ongoing misappropriations against Alberta Health,” Rosborough added.
According to the government lawyer, the amount of over-billing was so high, “there are few comparable physician embezzlement cases across Canada.” The Crown said the only apparent motive was ”unadulterated greed.”
“Shi often billed for one hour or more of ‘psychiatric counselling’ with a patient for a visit that, according to the patient, lasted 10-15 minutes,” said the agreed statement. “While she may have provided some services that may have fallen under that code, she would bill for psychiatric counselling on almost every patient that she saw, often for multiple units.”
In effect, Shi billed $1.38 million in 2016, over four times higher than the annual earning of an average family doctor in Alberta, who was billing about $306,000 annually. That year, she claimed 216 days of work, of which 208 were spent providing at least eight hours of psychiatric treatment, based on her billings.
Alberta Health’s billing structure allows physicians to operate on an honour system, using certain codes to bill for specific services. Court documents state that Alberta’s public fee-for-service model relies on “individual physicians truthfully reporting and billing for their services.”
The agreed statement of facts said $827,077 of the $1.38 million Shi billed was fraudulent. She had used the code for psychiatric services to bill the system at a higher pay rate. The initial allegations were that Shi had claimed between $3.5 million and $4.1 million in deceitful billings.
