Province drops second audit of former Sussex doctor's Medicare billings

Dr. Sunita MacMullin has been successful in halting a second audit of her Medicare billings from 2016-19. (Facebook - image credit)
Dr. Sunita MacMullin has been successful in halting a second audit of her Medicare billings from 2016-19. (Facebook - image credit)

New Brunswick's health department has agreed to stop an audit of a former Sussex doctor whose Medicare billings were among the highest in the province, ending her court challenge of the probe.

Dr. Sunita MacMullin in March filed for a judicial review of the province's second audit of her fees-per-service billings between 2016 and 2019.

That second review began after a separate audit examining her billings for 2019 to 2021 led to an order to repay the province more than $500,000.

MacMullin was consistently one of New Brunswick's highest-earning physicians in recent years before moving to Ontario. She billed the province about $1.8 million in 2020 and $1.6 million in 2021.

MacMullin had asked the court to quash the second 2016-19 audit and prohibit further audits of that period. Alternatively, she asked the court to halt the audit pending the outcome of a separate challenge of the 2019-21 audit results.

Consent order ends case

The case was scheduled to return to the Court of King's Bench in Moncton on Thursday.

However, a consent signed by MacMullin's lawyer and the province was filed this week ending the case.

The order says the province is prohibited from conducting another audit or review of MacMullin's billings for 2016-19.

The order doesn't say why the province has agreed to stop the audit.

Documents filed leading up to the consent order include affidavits from people involved in the audits and MacMullin's response to those affidavits.

An affidavit from Kim Smith, a monitoring and compliance officer with the health department, states provincial staff were in MacMullin's Sussex office in April 2021 to audit her billings.

Smith says MacMullin wasn't in the office when medical records indicate some procedures she billed took place.

It says electronic records show patients were seen by staff in MacMullin's practice, but allege MacMullin changed charts after-hours.

"These changes usually changed the nature of the visit from one that could not be billed, to one that was billable," Smith said. "Or one that was billable at a lower rate, to one that was billable at a higher rate."

Denies allegations

MacMullin's response filed this month says Smith's affidavit contains errors. She denies changing patient charts to inaccurately reflect patient visits.

"It was not my practice to bill for any patients I had not personally seen," MacMullin states.

MacMullin's request for a judicial review had also sought documents from the province about its previous audit.

The first 2016-19 audit resulted in "no adjustment or recoveries" to claims, MacMullin indicated in filings.

A letter from the province about the results of that audit praised her work and says documentation from her office was "clear, organized and consistent in nature."

However, documents in the court file indicate the subsequent 2019-21 audit led the province to want to re-examine the previous time period.

Smith's affidavit compared the number of times MacMullin used a billing code for an office visit, which can only be used when a physician sees a patient, to the average of other physicians.

In the 2016-17 fiscal year, MacMullin used the code 11,865 times compared to the average of 2,117.6.

In 2017-18, MacMullin used the billing code 14,115 times, compared to an average of 1,992.8.

In the 2018-19 fiscal year, Smith's affidavit says MacMullin used the code 17,294 times, compared to the average of 2,139.3.

MacMullin worked as a family physician in Fredericton until 2018, when she moved her practice to Sussex. She said she had too many patients and lacked "on call" support from other doctors.

Shortly after being told in February that she had to repay $552,315.80 within 30 days because of the 2019-21 audit, she quit her Sussex practice.

"As the stress of these Medicare matters became unbearable, I felt unwell. I was no longer safely able to practice medicine in this setting," MacMullin said in an affidavit.

The status of MacMullin's challenge of the results of the 2019-21 audit are not clear.

Her lawyers did not respond to a request for comment Thursday.

Geoffrey Downey, a spokesperson for the provincial government, said in an email that the province has no comment.