Winnipeg Free Press - PRINT EDITION

Doctor disciplined after billing for non-existent calls

Charged province for nurse practitioner's work

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A Winnipeg physician has been disciplined by the Manitoba College of Physicians and Surgeons for wrongfully billing the province for patients he never saw.

Dr. Richard Lloyd Letkeman billed Manitoba Health for $39,055.54 between November 2010 and April 2011 for house calls that were performed by a nurse practitioner who worked at the same clinic.

According to a report published on the college's website, the patient visits were billed to the province using Letkeman's billing number. Letkeman pocketed 30 per cent of the fees paid for the house calls, while the nurse practitioner, ostensibly acting under his supervision, received the rest.

"None of the records of the nurse practitioner/patient encounters for which Dr. Letkeman was responsible contain any indication of Dr. Letkeman's involvement in the care or any indication Dr. Letkeman had reviewed the record and signed off on the care provided," the college's investigation committee said in its report.

'None of the records of the nurse practitioner/patient encounters for which Dr. Letkeman was responsible contain any indication of Dr. Letkeman's involvement in the care'

Letkeman stopped billing for the nurse practitioner's visits when he learned the Health Department was investigating the invoices, the report said.

He has repaid the province for the nearly $40,000 in inappropriate billings. He's also had to pay the College of Physicians for the cost of its investigation -- $6,974.60.

A spokeswoman for Manitoba Health said in an email Friday the department has forwarded the matter to the Winnipeg Police Service.

The department spokeswoman said responsibility for fee-for-service billings rests solely with the physician -- not with the clinic or any of the doctor's associates.

Through an intermediary, Letkeman declined a request for an interview, referring a reporter to his lawyer.

A spokeswoman for the College of Registered Nurses of Manitoba, which licenses nurse practitioners, said she is prevented by law from confirming or denying whether one of its members is under investigation by that body.

The college of physicians did not name the nurse practitioner in its report, nor did it name the clinic where Letkeman worked. However, a woman who answered the phone at the Four Rivers Medical Clinic on Main Street confirmed on Friday the doctor was employed there at the time. He now works at another city clinic.

Dr. Bill Pope, registrar with the College of Physicians and Surgeons, said the public censure is no small punishment for a physician. It is "serious stuff for a doctor to have your name in the paper for being censured by your regulatory authority," he said.

The information is also made known to other provincial physician licensing bodies, he added.

The college chastised Letkeman for billing the province as though he actually saw the patients himself. It is also concerned the doctor failed to maintain proper patient records. "Those are very serious issues for us," Pope said.

The college's investigation committee reported Letkeman had agreed to supervise the nurse practitioner's care of patients during house calls. The NP had the use of a hand-held camera for visiting patients that allowed the doctor to see and hear what was occurring on location via a clinic computer. The system was tested in the clinic but it was never used on any house calls.

In an interview with the head of the college's investigation committee, Letkeman indicated he was aware one requirement for billing Manitoba Health was the physician personally see the patient.

"Dr. Letkeman relied upon assurances from the clinic owner if the bills in question were challenged, the clinic owner would succeed in a dispute with Manitoba Health," the report said.

"Dr. Letkeman's only independent inquiry as to the propriety of the billing system for the nurse practitioner's house-call visits was one telephone call to someone in Manitoba Health to ask if Manitoba Health had policies governing billing for the work of a nurse practitioner. When told there were no such policies, Dr. Letkeman made no further inquiries of Manitoba Health or anyone else."

larry.kusch@freepress.mb.ca

Republished from the Winnipeg Free Press print edition February 15, 2014 A5

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