Audit FAQ's

The number one question asked by physicians facing an audit is “why me?” Below is the answer to this question, along with additional frequently asked questions on audits.

For further information, please contact:

Ms. Juanita Grant
Manager, Audit & Billing
604 638 2829 or jgrant@doctorsofbc.ca

Alternate:

Ms. Tara Hamilton
Project Coordinator, Audit & Billing
604 638 6058 or thamilton@doctorsofbc.ca

Why me?

An audit may be initiated based on concerns resulting from any one or more of the following: 

  • Complaints, either from a member of the public or a colleague (another practitioner, MOA, or allied health professional);
  • Concerns by the Medical Services Plan about billing patterns;
  • Results of a Service Verification Audit;
  • Anomalies within the Practitioner Profile which are not readily explainable; and/or
  • Anomalies found upon review of billings or review of a sample of records.

Before an onsite audit takes place it must be approved by the Audit and Inspection Committee (AIC) of the Medical Services Commission which consists of four members, as follows:

  • A member of the public,
  • A physician member representing the Doctors of BC,
  • A physician member representing the College of Physicians and Surgeons of BC, and
  • A physician member representing the government of BC.
How long will the audit take?

The usual time frame for the onsite portion of the audit is 4-5 days.

Does the Medical Inspector look at all my medical charts?

No. On the first day of the onsite audit the Medical Inspector will ask for a random statistical sampling of patients’ records (usually 60 to 100 patient records, but this varies depending on the type of practice). The Medical Inspector will look at all documentation within those charts that are relevant to the fee items billed in the statistical sample, and not just the areas of concern which may have initiated the audit.

Do I have to close my practice during the on-site audit?

No, you do not. You should find a quiet room, away from patients, where the medical inspector and accountant can work. Assign an MOA to take care of retrieving medical records and anything else the audit team needs.

Do I need a lawyer present during the on-site audit?

If a practitioner wants a lawyer present, then the Medical Services Commission does not normally object. The lawyer attends as an observer only. If you do want a lawyer present, it would be appropriate to do so at the exit interview stage when the Medical Inspector and Auditor discuss their preliminary findings with you. 

When do I find out the results of the audit?

The Medical Inspector and the auditor will schedule an exit interview with you to go over, in general terms, the preliminary findings of the audit. After inspection of the records is completed and after the audit results have been reviewed, you will receive a copy of the Audit Report and the final error list.

Will my name be published?

The identity of the individual practitioner is kept confidential except in certain specific circumstances. Publication may be part of a settlement agreement or if the matter goes on to an Audit Hearing Panel, then yes, your name would become public as the Audit Hearing is open to the public.