The Canada Health Act specifically bans extra-billing and user charges for all "medically necessary" procedures, which must be covered by each province's medicare plan.
The Act defines these services, performed by physicians and/or hospitals, as "medically necessary for the purpose of maintaining health, preventing disease or diagnosing or treating an injury, illness or disability."
The Act does not permit private clinics such as the Cambie Surgery Centre to charge patients extra for medically necessary procedures.
However, applying and enforcing the Canada Health Act falls to the provinces, each of which has different regulations.
The federal government may punish violations of the Act only by withholding from its annual cash transfer to the offending province an amount equal to the sum of the transgressions.
In recent years, no province has been fined more for turning a blind eye to CHA violations than British Columbia.
From 2001 through 2005 B.C. was penalized $324,641 over extra-billing and user fees.
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