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Michael, Essam Samy Naguib

CPSO#: 65577

MEMBER STATUS
Active Member as of 01 Jul 1994
CPSO REGISTRATION CLASS
Restricted as of 08 Sep 2020

Summary

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Former Name: No Former Name

Gender: Male

Languages Spoken: Arabic, English

Education:University of Cairo, 1982

Practice Information

Primary Location of Practice
4303 Village Centre Court
Mississauga ON  L4Z 1S2
Phone: (905) 949 6999
Fax: (905)949 6908 Electoral District: 05

Additional Practice Location(s)

206
122295 HW 50
Bolton ON  L7E 1M2
Canada
Phone: 905 8571988
Fax: 905 949 6908
County: Regional Municipality of Peel
Electoral District: 05

220 Dundas St E
Belleville ON  K8N 5G8
Canada
Phone: 613 9627999
Fax: 905 9496908
County: County of Hastings
Electoral District: 06

300 Main street North
Suite 101
Brampton ON  L6V 1P6
Canada
Phone: (905) 451-4333
Fax: (905) 451-4324
County: Regional Municipality of Peel
Electoral District: 05

400 Bronte St S.
Milton ON  L9T 0H7
Canada
Phone: 9056931193
Fax: 9056931550
County: Regional Municipality of Halton
Electoral District: 04

Professional Corporation Information


Corporation Name: Dr. Essam Michael Medicine Professional Corporation
Certificate of Authorization Status: Issued Date:  Dec 11 2009

Shareholders:
Dr. E. Michael ( CPSO# 65577 )

Business Address:
220 Dundas Street East
Suite 210
Belleville ON  K8N 1E2
Phone Number: (613) 962-7999

Business Address:
210 - 12295 Highway 50
Bolton ON  L7E 1M2
Phone Number: (905) 857-1988

Business Address:
4303 Village Court Centre
Mississauga ON  L4Z 1S2
Phone Number: (905) 949-6999

Business Address:
300 Main Street North
Brampton ON  L6V 1P6
Phone Number: (905) 451-4333

Business Address:
105 - 400 Bronte Street South
Milton ON  L9T 0H7
Phone Number: (905) 693-1193

Hospital Privileges

Hospital Location
William Osler Health Centre Etobicoke General Site Toronto

Specialties

Specialty Issued On Type
Obstetrics and Gynecology Effective:30 Jun 1994 RCPSC Specialist

Registration History

Action Issue Date
First certificate of registration issued: Postgraduate Education Certificate Effective: 01 Jul 1992
Expired: Terms and conditions of certificate of registration Expiry: 30 Jun 1994
Subsequent certificate of registration Issued: Independent Practice Certificate Effective: 01 Jul 1994
Transfer of class of certificate to: Restricted certificate Effective: 08 Sep 2020
Terms and conditions imposed on certificate by Discipline Committee Effective: 08 Sep 2020

Practice Restrictions

Imposed By Effective Date Expiry Date Status
Discipline Committee Effective: 08 Sep 2020 Active
             As from September 8, 2020, by order of the Discipline Committee of the College
            of Physicians and Surgeons of Ontario, the following terms, conditions and
            limitations are imposed on the certificate of registration held by Dr. Essam
            Samy Naguib Michael:

                  i.    Dr. Michael will, at his own expense, retain an
                        obstetrician/gynecologist practice monitor approved by the College
                        to review Dr. Michael's Ontario Health Insurance Plan ("OHIP")
                        billings and the corresponding patient charts to ensure his
                        compliance with the Health Insurance Act and who will sign an
                        undertaking in the form attached to the Order as Schedule "A" (the
                        "Practice Monitor");
                  
                  ii.   The Practice Monitor will review twenty-five (25) of Dr. Michael's
                        patient charts for which he has billed OHIP once every three (3)
                        months for a minimum of two (2) years ("OHIP Monitoring"). If Dr.
                        Michael bills OHIP for fewer than twenty-five (25) patients in any
                        given three-month period, the Practice Monitor will review all of
                        the patient charts for which Dr. Michael billed OHIP. In the event
                        that Dr. Michael has billed OHIP for fewer than 200 patients during
                        the two-year period of monitoring, the monitoring will continue
                        until 200 charts have been reviewed;
                  
                  iii.  If a Practice Monitor who has given an undertaking in Schedule "A"
                        to this Order is unable or unwilling to continue to fulfill its
                        terms, Dr. Michael shall, within twenty (20) days of receiving
                        notice of same, obtain an executed undertaking in the same form
                        from a similarly qualified person who is acceptable to the College
                        and ensure that it is delivered to the College within that time;
                  
                  iv.   If Dr. Michael is unable to obtain a Practice Monitor in accordance
                        with paragraphs 4(i), 4(ii) and 4(iii) of this Order, he shall
                        cease to submit bills to OHIP until such time as he has done so;
                  
                  v.    Dr. Michael shall consent to the disclosure by his Practice Monitor
                        to the College, and by the College to his Practice Monitor, of all
                        information the Practice Monitor or the College deems necessary or
                        desirable in order to fulfill the Practice Monitor's undertaking
                        and to monitor Dr. Michael's compliance with this Order;
                  
                  vi.   During the period the OHIP Monitoring remains in effect, Dr.
                        Michael shall inform the College of each and every location where
                        he practises including, but not limited to hospitals, clinics, and
                        offices, in any jurisdiction (collectively, his "Practice
                        Location(s)"), within fifteen (15) days of this Order, and shall
                        inform the College of any and all new Practice Locations within 15
                        days of commencing practice at that location, for the purposes of
                        monitoring his compliance with this Order;
                  
                  vii.  During the period the OHIP Monitoring remains in effect, Dr.
                        Michael shall submit to, and not interfere with, unannounced
                        inspections of his Practice Location(s) and patient records by a
                        College representative for the purposes of monitoring his
                        compliance with this Order;
                  
                  viii. Dr. Michael shall consent to the monitoring of his OHIP billings
                        and cooperate with inspections of his practice and patient charts
                        by his Practice Monitor and College representatives for the purpose
                        of monitoring and enforcing his compliance with the terms of this
                        Order; and
                  
                  ix.   Dr. Michael shall be responsible for any and all costs associated
                        with implementing the terms of this Order.

Previous Hearings

Committee: Discipline
Decision Date: 08 Sep 2020
Summary:

On September 8., 2020, on the basis of an Agreed Statement of Facts and Admission, 
the Discipline Committee found that Dr. Essam Samy Naguib Michael (“Dr. Michael”) 
committed an act of professional misconduct in that he has been found guilty of an 
offence that is relevant to his suitability to practise. 
 
FACTS 
 
Dr. Michael is a 61-year-old obstetrician and gynecologist practicing in the Greater 
Toronto Area. He received his certificate authorizing independent practice from the 
College of Physicians and Surgeons of Ontario (the “College”) in 1994. 

 At the relevant time, Dr. Michael operated 4 fertility clinics in the Greater Toronto Area. 
 His primary clinic was located in Mississauga, with other offices in Brampton, Bolton, 
 and Milton. 

Provincial Offence Proceeding and Conviction 

  
 On November 14, 2018, Dr. Michael pleaded guilty to contravening s. 15 of the Health 
 Insurance Act by submitting billings to the Ontario Health Insurance Plan (“OHIP”), in the 
amount of $545,000, which did not comply with the requirements of the Schedule of 
Benefits, thereby committing an offence under the Health Insurance Act. The overbilling 
occurred over the period between January 1, 2007 and May 21, 2013. 
 
The proceeding took place at the Superior Court of Justice before Justice Dawson. The 
parties presented an Agreed Statement of Fact, which was read into the record. The 
Agreed Statement of Fact can be summarized as follows: 

   -   Billing code A935 requires that the physician spend a minimum of 50 minutes in 
      direct contact with the patient; 

   -  Between January 1, 2007 and May 21, 2013, Dr. Michael improperly billed OHIP for 
      numerous units of code A935 as he did not spend the requisite 50 minutes in direct 
      contact with the patient; 

   -  There is no dispute that Dr. Michael saw the patients for whom A935 was billed. 
      Rather than billing A935, he ought to have billed A205.  

   -  The amount of the overpayment is the difference between the two codes, which is 
      $545,000. 
 
A205 is the code for an Obstetrics and Gynaecology Consultation. A205 does not have a 
time requirement. A935 is a Special Surgical Consultation code. It can be billed by a 
surgeon who provides all the appropriate elements of a regular consultation and 
devotes at least fifty minutes exclusively to the consultation with the patient. 
 Dr. Michael admitted that he had submitted billings to OHIP in the amount of $545,000 
 that did not comply with the requirements of the Schedule of Benefits and was therefore 
 guilty of committing an offence under the Health Insurance Act, contrary to section 
 44(1)(a).  

 At the proceeding on November 14, 2018, Dr. Michael undertook through counsel to 
 repay the $545,000 to the Minister of Finance. A cheque from Dr. Michael’s counsel to 
 the Minister of Finance, dated November 21, 2018 confirms restitution in the amount of 
 $545,000.  

 The Crown and defence presented a joint submission on sentence, asking that the 
 minimum fine of $5000 be imposed. Justice Dawson accepted the joint submission and 
 ordered a fine of $5,000. 
  
 Circumstances of Overbilling 
  

 Dr. Michael delegated the responsibility of his OHIP billings to his staff.  
  
 Dr. Michael had inherited a billing system that allowed staff to enter shortcut keys 
 related to the type of patient visit, rather than directly entering the OHIP code. The billing 
 system then automatically populated billing codes based on the shortcut keys. A 
 forensic examination of Dr. Michael’s billing software demonstrated that the billing 
 codes associated with the shortcut keys were not always appropriate to the type of 
 patient visit.  
  
 One of the shortcuts used by staff was for “new patient”. This shortcut was entered by 
 staff when the visit pertained to a new fertility patient. The billing software 
 automatically populated the A935 code when this shortcut was entered, whether or not 
 Dr. Michael had spent the requisite 50 minutes with the patient as required by the 
 Schedule of Benefits. 
  
 Dr. Michael was unaware of this issue and its effect on his OHIP billing. Dr. Michael 
 nonetheless accepts responsibility for the improper billings submitted to OHIP. 
  
 PENALTY 

 Facts on Penalty 

In March 2020, the William Osler Health System (“William Osler”) reduced the availability 
of operating rooms for elective surgeries as a result of the COVID-19 pandemic. 
 Following this reduction in capacity, only two days per month were available for 
 OB/GYN surgeries. It is anticipated that William Osler will increase its capacity for 
 OB/GYN surgeries to one day per week beginning in September 2020. 

  
As a result of the reduction in operating room capacity between March and September 
2020, Dr. Michael has a backlog of 88 hospital-based surgeries he is scheduled to 
perform. These include surgeries for patients with gynecological conditions including 
infertility; significant pelvic pain secondary to endometriosis or large fibroids; and 
irregular and heavy periods related to conditions such as adenomyosis and submucosal 
fibroids. 

 

Order 

 

The Committee ordered: 

-Dr. Michael is to be reprimanded; 

- Dr. Michael’s certificate of registration is to be suspended for a period of one (1) 
month, commencing from November 15, 2020 at 12:01 a.m. 

- The Registrar is to impose terms and conditions and limitations on Dr. Michael’s 
certificate of registration as set out in detail in the Order, (re: monitoring Dr. Michael’s 
OHIP billings) 

- Dr. Michael is pay to the College costs in the amount of $6,000.00 within 30 days of 
the date of the Order.

Hearing Date(s): September 8, 2020

Concerns

Source: Other
Active Date: February 5, 2019
Expiry Date:
Summary:
FINDINGS OF GUILT
Essam Michael was found guilty of the following offence:

1. Submitting billings to the Ontario Health Insurance Plan that did not comply with the requirements of the Schedule of Benefits, contrary to Section15 of the Health Insurance Act (Ontario).

DATE: November 14, 2018
SENTENCE: Fine of $5,000
Dr. Michael repaid $545,000 to the Minister of Finance.