Doctors in B.C. are being warned by their regulator that double-dipping – charging "vulnerable" patients to access medical care while also billing the public system – is illegal.

The College of Physicians and Surgeons of British Columbia sent a letter Thursday to its almost 13,000 registrants in response to a Globe and Mail investigation that revealed how some doctor-owned private clinics charge patients for quicker access to necessary medical services, such as MRI tests and minor surgeries, which are supposed to be covered by the province.

"The articles provide a reminder of the challenges we face with system realities such as operating room shortages in public hospitals combined with increasing need and long wait times," college registrar Heidi Oetter wrote.

Story continues below advertisement

Picard: Health-care system a free-for-all for double-dipping doctors

"While charging patients directly for uninsured services is permissible if operationalized ethically and in compliance with applicable standards … it is never acceptable to improperly bill or charge an extra amount for a service covered by the [provincial] Medical Services Plan."

However, in an interview Friday, Dr. Oetter acknowledged that the rules against extra billing are enforced by the province, not the college. She indicated the college would only consider disciplining doctors if they were to charge fees patients can't afford or don't fully understand.

"We don't believe we have the authority to prohibit the billing of those fees – as long as the patients are fully informed," she said. "I do believe our conflict-of-interest standard puts the onus squarely on the physician. They must be mindful of the patient's ability to pay. They cannot exploit the vulnerable patients."

The Globe's investigation also highlighted two cases – in B.C. and Ontario – in which staff and doctors in public facilities directed patients to private clinics where those same physicians were shareholders. That led to another warning from the college.

"Referral to a facility where a physician holds a financial interest almost always creates a conflict of interest," Dr. Oetter said.

Meanwhile, the federal Health Minister spoke out again Friday about extra billing in an opinion piece for The Globe. Jane Philpott was responding to criticism that Ottawa hasn't done enough to address the problem.

Story continues below advertisement

"I will continue to use all tools at my disposal to uphold the law," Dr. Philpott said.

B.C. is the only province the federal government has fined in the past five years for allowing extra billing. Those levies totalled approximately a million dollars – a drop in the bucket compared with the tens of millions of dollars that flow through some 30-odd private clinics in the province every year.

"I've made it clear to my provincial counterparts that I have concerns about user fees and extra billing, and that our government will take further action, as required," Dr. Philpott said.

"Discussions are continuing with provincial and territorial partners to develop a stronger and more coherent approach to monitor and stop the practice of user fees across the country. Legislation at the provincial level must be enforced and people should not hesitate to report misconduct to authorities."

Earlier this week, the B.C. government also tried to deflect criticism by pointing out it has forced doctors to repay more than $21-million in fees in the past five years based on 135 audits of "inappropriate billing."

However, a closer look shows all that money was from doctors caught overbilling the province – in public hospitals or clinics – by charging inappropriately or for services not rendered. That type of overbilling has nothing to do with the illegal practice of charging patients extra fees through private clinics.

Story continues below advertisement

Provincial figures show only five of the 135 audits found extra billing and those cases "have not been settled." None of those audits was at a private clinic, where most double-dipping by doctors takes place.

B.C. has been stymied in its attempts to curb extra billing by a lawsuit launched by the Cambie Surgery Centre a decade ago. That clinic's lawyers convinced a judge that no action should be taken until the case is finished. It's expected to drag on for several more years because it is a constitutional challenge of the laws against extra billing and is ultimately headed to the Supreme Court of Canada.