The Case

The College received a complaint from an insurance provider. They noted that a clinic was recently audited due to the high volume of claims they had received under one physiotherapist’s registration number.

The insurance provider also noted that the clinic was contracted by Immigration, Refugees and Citizenship Canada to administer the Interim Federal Health Program. The physiotherapist’s registration number was often used to bill for orthotics under this program, and claims were frequently submitted before a physiotherapy assessment was conducted and before orthotics were dispensed.

The College appointed an investigator who obtained a selection of patient files from the clinic. In reviewing the files, several record keeping concerns were identified including no evidence of comprehensive assessments or reassessment, and limited documentation of objective information. In some cases, the patient records also lacked information that showed that orthotics were clinically indicated.

The physiotherapist noted that they worked at the clinic as an independent contractor on a part-time basis. The clinic was very busy after being accepted into the Interim Federal Health Program and management pressured the physiotherapist and other providers to treat an increasing number of patients. The physiotherapist acknowledged that they felt pressured by clinic management to recommend orthotics and other medical aids to patients participating in the Interim Federal Health Program, even if they weren’t clinically indicated.

The physiotherapist said that the clinic manager had control over the billing and did not allow the PT to audit their invoices. The clinic also used the physiotherapist’s registration number to bill for services after they resigned.

The Standards

As detailed in the Code of Ethics, each physiotherapist’s commitment to act with honesty and integrity is fundamental to the delivery of high quality, safe and professional services. In this case, the PT knowingly engaged in unethical conduct by providing and billing for services that were not clinically indicated.

According to the Fees, Billing and Accounts Standard, physiotherapists are responsible for any fee, billing or account that uses their name and registration number. Unfortunately, the PT’s registration number was misused by the employer, however it is the responsibility of the physiotherapist to be aware of how their name and registration number are being used.

Before accepting a job, physiotherapists should have a conversation with their employer about their professional obligations. This video outlines what you should ask.

Lastly, many patient records that were reviewed in this case did not meet the requirements of the Record Keeping Standard. PTs must maintain records that are well organized, understandable, accurate and provide rationale for the care provided.

The Outcome

The College has a zero-tolerance policy for inappropriate business practices. It’s unfortunate that the physiotherapist was pressured by their employer to provide physiotherapy treatment that was not clinically indicated, however the PT acknowledged that they should have been more assertive with their employer when asked to do things that went against their professional obligations.

These concerns, along with numerous issues with record keeping, were serious enough to require the physiotherapist to participate in a Specified Continuing Education and Remediation Program (SCERP) and receive a caution. All costs associated with the SCERP will be paid by the PT, and the caution will be listed on the Public Register permanently.

If you are faced with a similar situation, it is very important that you have a conversation with your employer about your professional obligations. As uncomfortable as it might be, it’s much better for you to have that conversation than face professional conduct concerns in the future.

Fees, Billing and Accounts Standard

Record Keeping Standard

Inappropriate Business Practices

Code of Ethics