Post-payment review process

Learn what to expect if claims are reviewed and understand the general factors the ministry considers in the post-payment review process

The Plan to Build Ontario Together Act included amendments to the Health Insurance Act to make OHIP more accountable, which included the introduction of a new physician payment review process in Ontario that is intended to be fair, impartial, accountable and transparent.

After the initial tabling of the bill, the OMA expressed serious concerns with many proposed provisions in Schedule 15, and the Minister of Health pledged to work with the OMA to find a fair and equitable solution.

The OMA and Ministry of Health entered into discussions and subsequently agreed to a series of amendments to Schedule 15 that removed many of the provisions that were most problematic for physicians, clarified the government’s intention and revised the audit process to ensure that it contains necessary procedural safeguards, while maintaining the overall objective of accountability and transparency, with a focus on education. In December 2019, the government introduced amendments to Schedule 15 of the bill, which subsequently passed.

Contact us

Members are encouraged to reach out to the OMA if they require further information or clarification, and to contact the CMPA if they require representation and assistance in responding to a post-payment audit.

The Post-Payment Accountability Steering Committee oversees the implementation of changes to the administration of OHIP payments and related processes.

Get an overview of the physician fee-for-service post-payment audit process.

Find a comprehensive breakdown of each step in a post-payment audit process.

Understand the process the MOH will use when utilizing OSRs during post-payment audits of OHIP billings.

Find educational resources that help with the accurate and appropriate payment for medical services and reduce claims payment errors.

Find answers to common physician questions about post-payment accountability and the audit process.