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The Globe and Mail

Mount Sinai staff probed for billing practices

A young boy runs pass Mount Sinai Hospital in Toronto Sunday March 16, 2003.

KEVIN FRAYER/Kevin Frayer/The Canadian Press

A handful of Toronto doctors are being investigated by the province's health-fraud unit after officers executed search warrants at Mount Sinai Hospital.

Officers searched a Toronto hospital in early June to collect documents said Ontario Provincial Police spokesman, Inspector Dave Ross, declining to directly identify the hospital.

Mount Sinai confirmed Friday night that it was searched.

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The hospital, with a sterling reputation for patient care and research, was not involved in the warrants, Insp. Ross said. He declined to elaborate on the exact date or targets of the warrant.

"We are aware that a search warrant was executed on Mount Sinai premises in June," hospital spokesperson Jackie De Souza told The Globe and Mail, adding that it is has "fully co-operated" with the OPP's investigation.

"The grounds of the investigation relate to the individual OHIP billing practices of certain persons. We are not aware of the result of the investigation," she said.

"We take these matters very seriously and should any wrongdoing be found, we will take immediate and appropriate action."

The investigation has been ongoing for months, said Insp. Ross, and no charges have been laid.

The search warrant was executed around the same time former Mount Sinai Hospital employees filed a defence claim in a contractual battle waged with the hospital earlier this year. That statement of defence accuses doctors in the Department of Oral Surgery of improperly billing the Ontario Health Insurance Plan and says the hospital knowingly allowed it to happen.

Ms. De Souza said she could not comment on whether the lawsuit is linked to the OPP's probe, saying the hospital does not want to compromise the investigation.

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The defence was in response to a lawsuit filed by Mount Sinai against Lisa Anne Mezo and Sonya June Sampson, accusing them of fraud, fraudulent conversion, fraudulent misrepresentation, breach of fiduciary duty and breach of contract, according to documents filed in the Ontario Superior Court of Justice.

Ms. Mezo and Ms. Sampson's jobs were terminated in the in the fall of 2009 after they were accused of fraud, according to the statement of claim filed Jan. 11, 2010. The Toronto residents had been working in the hospital's Department of Dentistry office, as an administrative assistant and office co-ordinator, respectively. Recording patient payments was part of their daily work.

On or around July 27 last year, clinic manager Sandy Duarte, who oversees transactions in the department, "raised concerns" with Ms. Mezo about irregularities in the records, including "excessive deletions of patient payments," the statement reads. Ms. Mezo resigned, then quickly asked for and got, her job back.

The next day, Ms. Duarte said she found similar problems with Ms. Sampson's records and spoke with her about them. The discoveries led hospital officials to launch a further internal probe, which found that the pair collected payments from patients, recorded them and gave receipts, then changed the records to delete part or all of the payments, the statement of claim reads.

The employees would then keep the money they deleted from the records for their own personal benefit, the hospital alleged.

They accused the former employees of embezzling at least $145,773.03 from November 2008 to July 2009.

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None of the allegations has been proven in court.

In their statement of defence, filed June 4, 2010, Ms. Mezo and Ms. Sampson denied the allegations against them and the hospital's assertion that it was unaware of the ongoing fraudulent practices before July 2009.

Instead, the hospital "tolerated a culture of overlooking improper billing practices by staff doctors" the employees said in their statement of defence.

They alleged in the defence that certain staff doctors were improperly billing OHIP, including George Sandor and Cameron Clokie, who both specialize in oral and maxillofacial surgery.

They alleged Dr. Sandor would bill OHIP for consulting with patients in the clinic while he wasn't present.

Dr. Clokie, they alleged, would bill OHIP for procedures that were never performed.

The statement alleged that Dr. Sandor and Dr. Clokie would each say the other was present for surgeries they conducted when he wasn't.

The allegations even name head of oral surgery Gerald Baker, saying he was also billing OHIP, claiming that other doctors assisted in surgeries when they weren't present.

Reached at his home Friday night, Dr. Clokie said he had not seen the statement of defence because he is not involved in the lawsuit.

He said the hospital's lawyer, Jim Patterson, told him the employees were filing fraudulent OHIP billings under different people's names and collecting cash from patients.

Dr. Baker and Dr. Sandor have not had an opportunity to respond to the allegations in the court documents and they could not be reached for comment Friday night.

Ms. Mezo and Ms. Sampson said in the statement that neither the head of surgery nor the clinic manager did anything to stop the fraudulent billing practices.

None of these allegations have been proven in court either.

However, the pair did admit to taking "cash payments" from Mount Sinai, the statement of defence read. Ms. Mezo said she took $6,800 while Ms. Sampson admitted to taking $5,992.00 from November 2008 to July 2009.

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