24.3 (1) Under any of the following circumstances, the Minister may, with respect to a claim for payment for a service provided by a licensee or potential licensee, refuse to pay for the service, pay a reduced amount for the service, pay for the service the Minister considers to have been provided and not the service described in the claim that was submitted or require reimbursement of the amount paid for the service: 1.  If the Minister is of the opinion that any or all of the following apply: i.  all or part of the service was not in fact rendered, ii.  the service has not been rendered in accordance with a requirement under this Act, or iii.  there is an absence of a record described in section 24.1. 2.  If the Minister is of the opinion that the nature of the service is misrepresented, whether deliberately or inadvertently. 3.  If the Minister is of the opinion that all or part of the service was not provided in accordance with prescribed quality and standards or, in the absence of regulations, not provided in accordance with generally accepted quality and standards for the facility and the service or services to be provided in the facility. 4.  In such other circumstances as may be prescribed. 2019, c. 15, Sched. 19, s. 15 (1). Statistical methods (2) The Minister may, in determining amounts to be reimbursed under this section, use a random sample with a reasonable confidence interval of claims submitted by the licensee in respect of a service during a specified period of time and calculate the amount to be reimbursed for that service for that period or a portion of that period by assuming the results observed in the random sample are representative of all of the claims submitted by the licensee for that service during the period in question. 2019, c. 15, Sched. 19, s. 15 (1). Pre-payment refusal to pay, pay reduced amount or substitute amount (3) Where the Minister is of the opinion that a circumstance described in subsection (1) exists and has made a decision to refuse to pay or pay a reduced amount to a licensee or potential licensee, or to pay for the service the Minister considers to have been provided and not the service described in the claim, the Minister shall notify the licensee or potential licensee of the decision and the action taken. 2019, c. 15, Sched. 19, s. 15 (1). Post-payment notice that reimbursement is required (4) Where the Minister has made a payment to a licensee or potential licensee and the Minister is of the opinion that a circumstance described in subsection (1) exists and that reimbursement to the Minister is required, the Minister shall notify the licensee or potential licensee of the decision to require reimbursement and the amount of reimbursement that is required. 2019, c. 15, Sched. 19, s. 15 (1). Recovery by Minister (5) The Minister may obtain or recover money that, in the opinion of the Minister, a licensee or potential licensee owes to the Minister by any method, including, without being limited to, set-off against any money payable to them under this Act or, in the event that the licensee or potential licensee is a physician, any money payable to them under the Plan, unless another method of payment is agreed to by the Minister. 2019, c. 15, Sched. 19, s. 15 (1). Not a decision (6) For greater certainty, a refusal to pay under section 24.2 is not a decision for the purposes of this section. 2019, c. 15, Sched. 19, s. 15 (1). Patient not to pay (7) No person shall charge or accept payment or other benefit from an insured person for a service that is the subject of a decision of the Minister under this section, except as may be provided for in the regulations, if any. 2019, c. 15, Sched. 19, s. 15 (1). Section Amendments with date in force (d/m/y) 2019, c. 15, Sched. 19, s. 15 (1) - 10/12/2019