Professional misconduct in Ontario medical practice can take many forms. Some cases involve serious clinical errors with catastrophic consequences. Others involve sexual abuse or grooming behaviour that betrays the foundational trust of the doctor-patient relationship. Still others involve large-scale billing fraud against OHIP that defrauds the public system of millions of dollars.
CPSO v Li, 2024 ONPSDT 11, is a different kind of case. The sums of money involved are small — twenty dollars per Accessible Parking Permit application. The clinical work was routine. The misconduct was sustained but quotidian. And yet the Ontario Physicians and Surgeons Discipline Tribunal suspended the physician’s licence for twelve months and ordered an ethics course at his own expense. The case is doctrinally significant because it engages two interrelated frameworks that often operate together but are doctrinally distinct: fee misconduct under the OMA Physician’s Guide to Uninsured Services, and the records standard for clinical documentation supporting professional certifications.
The case also illustrates the spectrum of financial misconduct in CPSO discipline. The penalty sits between earlier financial cases in this rewritten library — substantially less than the revocation in Kadri (multi-million dollar billing fraud) but more than other categories of low-level professional fault. The calibration is doctrinally useful for understanding where sustained fee misconduct combined with records failures falls in the broader CPSO disciplinary landscape.
The Accessible Parking Permit program
The Accessible Parking Permit (APP) is a real government program administered under the Highway Traffic Act and related regulations. The program permits the holder to park in designated accessible parking spaces. Eligibility is restricted to people with disabilities meeting specific health criteria.
The application process requires medical certification. A regulated healthcare practitioner — typically a physician, but also including certain other regulated professionals — must complete a section of the application form certifying that the applicant has one or more of the eligible health conditions. The form requires the practitioner to indicate whether the condition is permanent, temporary, or subject to change.
The eligible conditions include various forms of mobility impairment, cardiac and respiratory conditions limiting walking distance, certain visual impairments, and other health conditions affecting accessibility. The categories are specific and have associated functional descriptors. One of the most common categories requires that the applicant cannot walk without the assistance of another person or a mobility device (such as a cane, walker, or wheelchair).
The integrity of the certification process matters for two reasons. First, it protects accessible parking spaces for the people who genuinely need them — supply is limited, and abuse of the system displaces those who depend on the spaces. Second, the certification operates as an attestation to a government program; like any such attestation, the underlying professional integrity of the signature matters.
The OMA Physician’s Guide to Uninsured Services
The Ontario Medical Association publishes a Physician’s Guide to Uninsured Services (commonly the “OMA Guide”). The Guide provides direction to physicians about which services they may charge for outside of OHIP billing and which they may not. The Guide is not legally binding in the same way as a statute, but it operates as the recognized professional standard for billing practice in Ontario.
The Guide categorizes services into those that may be billed to patients, those that are covered by OHIP, and those that physicians cannot charge for at all. The APP application is in the third category. The OMA Guide explicitly states that physicians cannot charge for completion of an APP application. The reasoning is that the APP application is a public-interest form that supports access to a government program; making physician certification a paid service would create a financial barrier to accessibility.
Where a physician charges for a service the OMA Guide prohibits, the conduct is treated as professional misconduct under the Health Professions Procedural Code (Schedule 2 to the Regulated Health Professions Act, 1991). The catch-all of “disgraceful, dishonourable or unprofessional” conduct applies. The doctrinal basis is that the OMA Guide reflects the recognized professional standard, and conduct that departs from that standard for financial gain is professional misconduct regardless of the dollar amounts involved.
The substantive case
Dr. Heung-Wing Li practised as a family physician. Between approximately 2014 and 2020 — a period of about six years — he charged patients up to $20 per completed APP application. The OMA Guide prohibited any charge for these applications throughout the relevant period. The OPSDT found that Dr. Li had improperly accepted money for completing APP applications, in violation of the recognized professional standard.
The CPSO investigation went further. The College retained a physician assessor to review patient charts and provide an opinion on Dr. Li’s APP application practice. The assessor reviewed nine patient charts and the corresponding APP applications.
The findings were substantial. For eight of the nine patients, the assessor concluded that Dr. Li had failed to maintain the standard of practice of the profession. The charts did not contain sufficient documentation to explain why the patients would be eligible for an APP. Specifically:
- For seven patients, the APP applications certified that the patient was unable to walk without the assistance of a person or device. However, the corresponding charts had no documentation of any such assistance being required.
- For three of those seven patients, the charts actually documented normal gait — a finding that directly contradicted the APP certification of inability to walk without assistance.
The combination is doctrinally serious. The first finding — fee misconduct — is a violation of the OMA Guide framework. The second finding — unsupported (and in some cases contradicted) certifications — is a violation of the records standard and the integrity of professional attestation. Each is independently significant. Together, they form a pattern of conduct that undermines both the financial integrity of medical practice and the documentary integrity of medical records.
The records standard for professional certifications
A doctrinal point that emerges from Li — and that extends well beyond the APP context — is the standard for clinical documentation supporting professional certifications. The general principle: where a physician signs a form, prescription, referral, or attestation requiring professional certification, the underlying chart must document the clinical findings supporting the certification. This includes:
- Forms attesting to medical eligibility for government programs (APP, ODSP, CPP-D, employment insurance sickness benefits, accessible transit programs)
- Sick notes and return-to-work certifications
- Prescriptions for controlled or restricted medications
- Referrals to specialists (where the referral attests to clinical indication)
- Disability claim forms for insurance
- School and workplace accommodation forms
The standard operates at two levels. At the affirmative level, the chart should contain documentation of the clinical findings that support the certification. At the negative level, the chart should not contain findings that contradict the certification. Where the chart is empty on the relevant question, or worse, where it documents findings inconsistent with the certification, the certification is unsupported by the contemporaneous clinical record.
The doctrinal consequence: unsupported certifications can constitute professional misconduct independent of any fee or financial dimension. A physician who certifies disability for a patient whose chart documents normal function has departed from the professional records standard. The certification itself becomes evidence of misconduct because it cannot be reconciled with the contemporaneous documentation.
For practising physicians, the operational lesson is significant. Form-signing practice should always include a contemporaneous chart entry documenting the clinical findings supporting the certification. The note need not be extensive — but it must exist, and it must be consistent with the certification. The absence of any supporting documentation creates exposure that operates independently of any other aspect of the practice.
The penalty calibration
The OPSDT ordered:
- A 12-month suspension
- An ethics course at Dr. Li’s own expense
Twelve months is in the moderate-to-significant range for non-revocation discipline. The relevant calibration factors:
- Duration of misconduct: Six years is sustained, not isolated.
- Combination of fee and records misconduct: Each is independently serious; together they support a higher calibration than either alone would warrant.
- Number of affected patients: Nine charts reviewed with eight showing standards failures suggests the pattern extended through the broader practice population, not limited to outliers.
- Government program integrity: APP applications are submitted to a public program; the misconduct extends beyond the doctor-patient dyad to the broader administrative system.
- Mitigation: The dollar amounts per individual transaction were small ($20). Patients suffered no clinical harm. The misconduct did not involve disclosure of confidential information or other downstream consequences for the individuals involved.
The ethics course at own expense reflects the focused nature of the misconduct. Where the misconduct is more about professional norms than about clinical competence, ethics training is the targeted remedial response.
The CPSO financial misconduct sub-cluster — three cases
CPSO v Li is the third case in the financial misconduct sub-category of the rewritten CPSO discipline cluster. Together with the earlier two cases, the sub-cluster now spans the spectrum:
- CPSO v Kadri: nephrologist; large-scale billing fraud involving multiple millions of dollars; licence revocation plus $250,000 in costs
- CPSO v Karim: physician facilitating non-resident OHIP use (a different form of system fraud); suspension
- CPSO v Li (this case): family physician; small-scale fee misconduct combined with records/false certification; 12-month suspension plus ethics course
The three cases illustrate the spectrum of financial misconduct discipline. At the most serious end, large-scale system fraud against OHIP produces revocation and substantial costs. At the lower end, sustained small-scale fee misconduct combined with records failures produces a 12-month suspension. The distinguishing factors include the dollar amounts involved, the duration of the conduct, the breadth of affected patients or systems, the nature of any deception, the presence of independent records misconduct, and the physician’s response to the investigation.
The broader CPSO discipline cluster
Li brings the rewritten CPSO discipline cluster to eleven distinct cases across four substantive sub-categories:
COVID-19 misinformation (4 cases):
- CPSO v Luchkiw (refusing investigation)
- CPSO v Phillips (COVID-19 communications)
- CPSO v Trozzi (highest-severity case)
- CPSO v Turek (lower-end joint submission)
Sexual abuse and boundary violations (3 cases):
- CPSO v Stein (attempting to date patient)
- CPSO v Iannantuono (inappropriate touching)
- CPSO v Peirovy (non-compliance with order)
Financial misconduct (3 cases — now expanded):
- CPSO v Kadri (large-scale fraud; revocation)
- CPSO v Karim (non-resident OHIP fraud; suspension)
- CPSO v Li (this case — small-scale fee + records misconduct; 12-month suspension)
Privacy breaches (1 case):
- CPSO v Mercado (unauthorized records access)
The cluster now spans the four most common categories of CPSO discipline with substantive coverage in each. For prospective clients, practising physicians, and the bar, this is a useful comprehensive reference set.
The doctrinal lessons
The case stands for several propositions.
Fee misconduct does not require large dollar amounts. Charging twenty dollars for a service the OMA Guide prohibits is fee misconduct. The size of the individual transaction does not determine whether the conduct constitutes professional misconduct; the question is whether the conduct violates the recognized professional standard. Where the OMA Guide prohibits a charge, charging is misconduct regardless of the amount.
The OMA Guide operates as the recognized standard for billing practice. Although not legally binding in the same way as a statute, the OMA Guide reflects professional norms that the CPSO and the OPSDT apply through the Health Professions Procedural Code catch-all. Physicians who depart from the OMA Guide for financial gain face professional misconduct exposure.
Professional certifications require chart support. Where a physician signs a form, prescription, referral, or attestation requiring professional certification, the underlying chart must document the clinical findings supporting the certification. The standard operates affirmatively (the chart should contain supporting documentation) and negatively (the chart should not contradict the certification).
Records misconduct can be independently serious. Unsupported certifications are professional misconduct independent of any fee dimension. A physician who signs a form attesting to disability for a patient whose chart documents normal function has departed from the records standard. The fee dimension makes the misconduct worse; the records dimension stands on its own.
Government program attestations matter beyond the doctor-patient relationship. APP applications, ODSP forms, CPP-D applications, and similar government-program certifications carry implications beyond the individual patient. The integrity of the broader program depends on the integrity of professional certifications. Misconduct in this context attracts disciplinary attention partly because of the systemic implications.
Penalty calibration reflects multiple factors. Twelve months reflects the duration of the misconduct, the combination of fee and records dimensions, the breadth of affected patients, the systemic implications, and the mitigation factors. Different combinations of factors produce different calibration outcomes. The spectrum of financial misconduct discipline runs from focused remedial measures to revocation, with sustained mid-range misconduct producing suspensions in the moderate-to-significant range.
Why this case matters
For prospective patients. Physicians cannot charge for completing certain forms — including the APP application. If you have been charged for an APP application or similar uninsured form completion, the OMA Guide framework provides the reference point. The CPSO complaint process is available for fee misconduct as well as for clinical care concerns. For more on the complaint process, see Should I File a CPSO Complaint? and A Patient’s Guide to Making Complaints About Health Care in Ontario.
For practising physicians. The case is a reminder that form-signing practice requires both compliance with the OMA Guide (no charging for prohibited services) and adequate chart documentation supporting any certifications. Where the OMA Guide prohibits a charge, do not charge — the dollar amounts are not the point. Where a form requires certification of medical eligibility, document the supporting clinical findings in the chart contemporaneously. The absence of supporting documentation creates exposure independent of any fee dimension.
For the disability community and APP applicants. The case illustrates the protective function of professional discipline in maintaining the integrity of accessibility programs. Where physician certifications are unsupported (or worse, contradicted by the chart), the entire APP program is undermined. The OPSDT’s response — substantial suspension plus ethics training — reflects the seriousness with which the discipline framework treats this kind of misconduct.
For counsel. The case is useful precedent on:
- The CPSO discipline framework as applied to fee misconduct combined with records issues
- The penalty calibration for sustained small-scale fee misconduct (12-month suspension as benchmark)
- The records standard for professional certifications
- The OMA Guide as operative authority on uninsured service billing
For more on the broader CPSO discipline framework, see the cases linked in the financial misconduct sub-cluster section above.
Decision Date: March 28, 2024
Jurisdiction: Ontario Physicians and Surgeons Discipline Tribunal
Citation: College of Physicians and Surgeons of Ontario v Li, 2024 ONPSDT 11 (CanLII)
Penalty: 12-month suspension + ethics course at own expense
Key authorities: Health Professions Procedural Code (Schedule 2 to the Regulated Health Professions Act, 1991); OMA Physician’s Guide to Uninsured Services; Accessible Parking Permit program under the Highway Traffic Act (Ontario)
