Edmonton doctor who over-billed Alberta Health more than $800k sentenced to four years in prison
An Edmonton doctor who over-billed Alberta Health for more than $800,000 in a single year has been sentenced to four years in prison.
Court of King’s Bench Justice Paul Belzil on Thursday imposed the sentence on Dr. Yifei Shi, who admitted to a count of fraud over $5,000 for claiming she provided psychiatric services to almost every patient who used her family medicine clinic in west Edmonton.
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Crown prosecutors Megan Rosborough and Leah Boyd had asked for a sentence of five years, while defence lawyer Kent Teskey suggested two-and-a-half. The Crown argued the only apparent motive for the crime was “unadulterated greed.”
“Yifei Shi was a mature individual who had the privilege of employment in a job earning over $500,000 per year,” Rosborough said in a written submission.
“She had every advantage in life: education, wealth and a great job. She used all of these advantages to perpetrate ongoing misappropriations against Alberta Health.”
The total value of the misappropriations “is so high that there are few comparable physician embezzlement cases across Canada,” Rosborough added.
Shi began practicing medicine in Alberta in 2013. Under Alberta’s public fee-for-service health-care model, she was entitled to claim billings from Alberta Health using codes for specific medical services.
Because of the large number of claims, the billing structure operates on an honour system that relies on “individual physicians truthfully reporting and billing for their services,” court documents state.
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Beginning in 2016, however, Shi began billing the government for in-office psychiatric treatment for nearly every patient, regardless of the actual treatment she provided.
“Shi often billed for one hour or more of ‘psychiatric counselling’ with a patient for a visit that, according to the patient, lasted 10-15 minutes,” an agreed statement of facts states. “While she may have provided some services that may have fallen under that code, she would bill for psychiatric counselling on almost every patient that she saw, often for multiple units.”
This allowed Shi, who is in her 30s, to bring home more than four times of what an average family physician makes. In 2016, Shi billed $1.38 million, at a time when the average general practitioner in Alberta was billing about $306,000 annually. In 2016, Shi claimed 216 days of work, of which — according to her billings — 208 were taken up providing at least eight hours of psychiatric treatment.
On Thursday, Shi admitted she did not provide those treatments in the amounts claimed. In all, $827,077 of the $1.38 million billed in 2016 was “fraudulent based on her deceitfully using the (psychiatric treatment) code as a billing multiplier,” the agreed facts state.
The Crown said this had trickle-down effects on patients, who were often “confused and upset” when they learned their family doctor was under investigation.
“The creation of false or misleading health care entries on a patient health chart could have long-term impacts on their treatment options and their ability to access health or life insurance,” the Crown’s submissions state.
Shi was arrested by the Edmonton police economic crimes section in May 2021 after a request from Alberta Justice. She was charged with a count of fraud over $5,000, as well as theft in the same amount. She was initially alleged to have claimed between $3.5 and $4.1 million in fraudulent billings.
A CPSA news release at the time said Shi agreed to withdraw from practice after the criminal charges were laid. CPSA spokeswoman Andrea Garland said Shi’s practice permit remains active, adding the organization usually conducts its own investigations under the Health Professions Act after a criminal case is concluded.
In addition to the four years in jail, Shi has been ordered to repay the $827,000 owed to the Alberta government. Teskey, her lawyer, declined to comment.https://calgaryherald.com/news/crime/edmonton-doctor-who-over-billed-alberta-health-more-than-800k-sentenced-to-four-years-in-prison/wcm/99197ee6-df79-4f18-a8fe-5d9677a384eb