Tuesday, September 1, 2026
The Recovery
In Canada, physician services are funded almost entirely from one public pool. When a bill is wrong there is no second payer to absorb the loss. The Recovery documents the machine that claws a portion of it back: a legislated Saskatchewan peer committee, a 15-month review window,
Ten things
- The public and private split has been stable for two decades, with the private share around 30 per cent of the total and concentrated in drugs, dental, and vision, not in physician or hospital care.
- Department of Justice False Claims Act settlements and judgments exceeded $6.8 billion in fiscal year 2025, the highest annual total in the statute's history, with about $5.7 billion from healthcare matters.
- And US beneficiaries receive summary notices, so the transaction is at least partly visible, while Canadian patients generally see nothing, removing a whole channel of citizen-surfaced complaint.
- Ontario's schedule runs to more than 5,000 codes, and more codes means more adjacent pairs where substitution or unbundling is possible.
- The figures here are CIHI National Health Expenditure estimates; the over-98-per-cent figure is the load-bearing one, and it rests on CIHI's own series.
- The Branch publishes a three-year summary of all monies ordered repaid by physicians because of inappropriate billings or an inappropriate pattern of practice.
- National estimates put the public share of physician spending at over 98 per cent, and the public share of hospital spending at roughly 90 per cent.
- The annual National Health Care Fraud Takedown is a publicized event; one 2025 takedown charged 324 defendants over $14.6 billion in alleged fraud.
- The Joint Medical Professional Review Committee , the JMPRC, is a legislated physician peer-review committee, with two physicians appointed by each of the Saskatchewan Medical Association, the College of Physicians and Surgeons of Saskatchewan, and the Ministry of Health.
- OHIP "largely functions on the honour system, in part due to the sheer volume of claims submitted." Most billings are processed and paid automatically, and payment by OHIP does not indicate that a service was medically necessary or actually performed.
Five questions
Which term completes this sourced statement? “The public and private split has been stable for two decades, with the private share around 30 per cent of the total and _____ in drugs, dental, and vision, not in physician or hospital care.”
Which term completes this sourced statement? “And US beneficiaries receive summary notices, so the transaction is at least partly visible, while _____ patients generally see nothing, removing a whole channel of citizen-surfaced complaint.”
Which term completes this sourced statement? “The figures here are CIHI National Health _____ estimates; the over-98-per-cent figure is the load-bearing one, and it rests on CIHI's own series.”
Which term completes this sourced statement? “_____ estimates put the public share of physician spending at over 98 per cent, and the public share of hospital spending at roughly 90 per cent.”
Which term completes this sourced statement? “The Joint Medical _____ Review Committee , the JMPRC, is a legislated physician peer-review committee, with two physicians appointed by each of the Saskatchewan Medical Association, the College of Physicians and Surgeons of Saskatchewan, and the Ministry of Health.”