The Medical Services Plan (MSP) fee-for-service system requires a large element of trust that physicians will bill appropriately for their services, and audits by the MSC reveal that this trust is usually well founded. Very few physicians bill inappropriately. Of those who do, a large number of them do so unknowingly, usually due to billing errors. Fewer yet do so fraudulently.
The Medicare Protection Act provides the MSC with the legislated authority to audit physicians. The Audit and Inspection Committee (AIC) is responsible for the auditing and inspection of the practices of medical practitioners and has been delegated the powers and duties of the MSC under the Act.
The Patterns of Practice Committee (POPC), an Advisory Committee to the MSC, and jointly funded by Doctors of BC and MSP, has no authority to audit, but does have the mandate to provide advice to the MSC, and to provide educational information to physicians in regards to their practice and billing.
The POPC also provides advice to the MSP Audit Working Group regarding appropriate case-finding criteria for selecting audits, audit criteria, and process criteria to ensure physicians are treated fairly.
Download The Audit Process pdf, including full notes on each phase and step.