Dr. Janet Ann D'souza also ordered to repay funds and undergo supervision after billing violations
The Ontario Physicians and Surgeons Discipline Tribunal, in College of Physicians and Surgeons of Ontario v. D’souza, 2025 ONPSDT 27, has suspended Dr. Janet Ann D’souza’s certificate of registration for 12 months after finding that she failed to ensure her Ontario Health Insurance Plan (OHIP) billings were correct for mental health services. The decision, dated September 25, 2025, followed Dr. D’souza’s admission of misconduct and a joint submission on penalty by both parties.
Improper billing practices and investigation
Dr. D’souza practised general family medicine at an urgent care clinic in Whitby, Ontario, between 2014 and 2016. At the end of each working day, she would note her billing codes on a day sheet, which clinic staff then used to submit claims to OHIP. Under the Health Insurance Act, she was deemed to have personally submitted these claims and was responsible for any billing errors.
The claims at issue involved time-based billing codes for mental health care, specifically K005 (Primary Mental Health Care) and K013 (Individual Psychotherapy). The OHIP Schedule of Benefits requires physicians to spend a minimum amount of time with patients for each unit billed and to document the start and end times for each service in the patient’s record.
The Tribunal found that claims were submitted on Dr. D’souza’s behalf for time-based mental health care services she did not provide, including several instances where more than 24 hours of services were billed in a single day. There was no suggestion that Dr. D’souza acted intentionally; however, she was found legally and ethically responsible for these claims.
In 2021, Dr. D’souza pled guilty in the Ontario Court of Justice to contravening the Health Insurance Act by receiving payments for claims to which she was not entitled. The agreed facts presented to the judge included that, on May 7, 2015, and April 16, 2016, some claims for K-Codes did not meet the Schedule’s conditions. On those dates, OHIP calculated billing errors resulting in losses of $2,000 and $4,000, respectively. The court ordered her to pay a fine of $6,000 and to repay a further $6,000 to OHIP.
A subsequent College investigation revealed additional improper billings not part of the court proceedings. OHIP’s analysis identified, on 23 service dates between 2014 and 2016, claims billed for more than 18 hours of time-based services, with three dates exceeding 24 hours. In July 2025, Dr. D’souza voluntarily repaid OHIP a further $65,000.
Tribunal findings and penalty
The Tribunal emphasized that Ontario’s health care system relies on physicians to ensure that their OHIP billings are careful and accurate. Even unintentional overbilling breaches the trust that Ontarians place in the medical profession regarding the use of public money.
The Tribunal accepted the joint submission, which included a 12-month suspension of Dr. D’souza’s certificate of registration, a requirement to complete the PROBE Ethics & Boundaries Program, and supervision and monitoring of her OHIP billings for three years following her return to practice. She was also ordered to pay $6,000 in costs.
The Tribunal noted that while the misconduct was serious, there was no finding of intentional wrongdoing. Dr. D’souza’s voluntary repayment, cooperation, and acceptance of responsibility were considered mitigating factors in determining the penalty.
