TWELVE Manitoba doctors topped the medical millionaire mark in billings to the province last year, including one pathologist who claimed $9.2 million in fees.
Five years ago, Dr. Allan Micflikier, a specialist in large intestine disorders, was the only physician who billed the province for seven figures.
There are now more than 80 doctors who billed the province for more than $500,000 -- almost triple the number from 2002.
Four pathologists topped the list of the highest billers, including Dr. Jenisa Naidoo, who billed $9,292,921, Dr. John Trainor, who billed $6,542,840, Dr. Shireen Naidoo, who billed $4,532,174 and Dr. Harry Wightman, who billed $3,788,636.
Terry Goertzen, acting assistant deputy minister for Manitoba Health, said the high fee is partially because all four work as lab directors and bill the province on behalf of the group of physicians who work at their lab for efficiency sake.
Goertzen said pathologists are also diagnosing more blood and tissue samples than a few years ago.
"There's been an increase in their tariff and clearly the volume they're seeing is higher," Goertzen said. "The public may have seen there are more what people call bleeding stations, where you can draw blood and get it tested."
The latest list of the province's high rolling medical specialists was disclosed in Manitoba Health's recently released 2006-07 annual report.
The majority of the province's 2,300 doctors bill Manitoba Health for every service they provide to a patient -- whether it's for orthopedic surgery or removing earwax. Only a handful of doctors at community clinics are paid a salary.
The fee, or tariff, is set for 3,000 different medical procedures and is re-adjusted every three years through negotiations between Manitoba Health and the Manitoba Medical Association.
Goertzen said tariffs are adjusted to ensure Manitoba remains competitive with other provinces and to ensure doctors are compensated for their time. The most common bill the province received was for a patient visit over 10 minutes.
Goertzen said a portion of the fee goes towards paying overhead costs, for things like needles and gloves and the lab or clinic space where the physician works. The rest of the money goes directly to the physician.
"You will see increasing incomes," Goertzen said.
"It's telling us (physicians) are obviously in high demand and providing a number of services and procedures."
Winnipeg-based radiologists, eye surgeons and cardiologists were among Manitoba's top billers, along with Brandon-based general surgeon Dr. Sonny Dhalla.
Dhalla is the only medical millionaire that does not work with diagnostic technology or specific organs like the heart or eye.
Carmel Olson, CEO of Brandon Regional Health Authority, said Dhalla is known for his hard work ethic and long hours. He is also using non-invasive technologies that other Brandon surgeons are not.
"I don't think this man works less than 14 to 16 hours a day," Olson said. "He's a very hard worker and he does a number of procedures that are not common to every general surgeon."
In the last year, two Manitoba doctors were flagged for overbilling.
Goertzen said all fee-for-service bills are entered into a computer that pinpoints when a bill appears suspicious.
Doctors have to explain whether the mistake was an accidental error or intentional, and have to repay the money.
"We will recover some money," Goertzen said. "It varies from a few hundred dollars to a few thousand dollars depending on what we've found."
A Manitoba Health audit and investigations committee also looks into the practices of some of the province's top billers to see if there's anything unusual. The province sends each doctor a list that compares their billing practice with their peers so they can adjust their billing patterns accordingly.
"When there is inappropriate billing, we have a very good system in place to catch (it)," Goertzen said, noting the names of the physicians who overbilled are not made public.
jen.skerritt@freepress.mb.ca
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