Ontario's top court has refused to hear an appeal by the Ontario Health Insurance Plan (OHIP) in the case of a Kingston physician ordered to repay more than $600,000 tied to pandemic-era COVID-19 vaccination clinic billings, marking another significant legal victory for Dr. Elaine Ma.
In a brief endorsement released May 8, a three-judge panel of the Court of Appeal for Ontario denied OHIP’s request for leave to appeal a December 2025 Divisional Court ruling that had partially favored Ma. The panel - Justices Jonathon C. George, David M. Paciocco and Julie Thorburn - considered the matter in writing before dismissing OHIP’s application, according to a report from Kingstonist.
“Leave to appeal is denied,” the endorsement stated. The court also ordered OHIP to pay $5,000 in legal costs to Ma. In an email shared with Kingstonist, Ma’s lawyer confirmed the outcome shortly after the decision was released.
Ma organized 48 mass vaccination clinics in Kingston during the COVID-19 pandemic and was later ordered by OHIP to repay $600,962 because of alleged billing non-compliance. That repayment order was previously upheld by the Health Services Appeal and Review Board (HSARB).
However, in a decision released on Dec. 16, 2025, Ontario’s Divisional Court found it was unreasonable for the Board to conclude that the COVID-19 pandemic did not constitute an “extenuating circumstance” when assessing Ma’s billings.
Rather than overturning the repayment order outright, the Divisional Court sent the matter back to HSARB to reconsider how much, if anything, Ma should be required to repay.
OHIP subsequently sought leave to appeal that ruling, arguing the Divisional Court had improperly interfered with the Board’s findings and misapplied the legal standard for judicial review. The Court of Appeal’s refusal to grant leave means the Divisional Court ruling now stands, the report said.
The matter is expected to return to HSARB, which must revisit the repayment issue while taking into account the Divisional Court’s findings about the extraordinary operational pressures physicians faced during the pandemic vaccine rollout.
In a statement previously provided to Kingstonist following the Divisional Court ruling, Ma said the ongoing litigation sent a troubling message to doctors who stepped up during the public health emergency.
“Doctors were asked to move quickly, adapt constantly, and vaccinate as many people as possible,” Ma said at the time.
The decision comes at a time when provinces are trying to rebuild capacity and morale in the health-care workforce. Aggressive efforts to claw back pandemic-related billings could have a chilling effect on physician willingness to participate in future emergency programs.
By directing HSARB to treat the pandemic as an extenuating circumstance, the courts have effectively signalled that emergency public-health directives and billing frameworks cannot be viewed in isolation.
The case is also a notable example of how courts may expect regulators to factor in emergency conditions when reviewing physicians’ conduct and billing. Although the dispute centres on OHIP billings rather than clinical negligence, the Divisional Court’s emphasis on “extenuating circumstances” during the vaccine rollout suggests pandemic-era decisions will not always be judged strictly by peacetime administrative standards.
For now, the Court of Appeal’s decision leaves intact a lower-court finding that the unprecedented realities of the COVID-19 vaccine rollout - a campaign strongly promoted by the provincial government - could not simply be ignored when evaluating physicians’ actions during one of the largest vaccination efforts in Ontario’s history.
The news outlet said it has reached out to Ma for comment on the latest development.
