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British Columbia cracks down on doctors’ illegal billing with stiff penalties

The B.C. government has moved against doctors who engage in illegal extra billing, enacting a law that aims to end queue-jumping by patients who pay to fast-track access to publicly funded medical care.

British Columbia leads the country in extra-billing practices, triggering penalties levied by Ottawa every year since 2001 for violations of the Canada Health Act.

An investigation by The Globe and Mail found significant, unlawful extra billing by Canadian doctors through private clinics – especially in British Columbia – where patients pay out of pocket for access to everything from medical appointments to surgery.

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Investigation: Some doctors are charging both government and patients privately in illegal double-dipping practice

Those findings were recently confirmed in a series of audits conducted jointly by the federal and B.C. governments, which led to the province’s most significant fine to date −$15.9-million. Before this year, fines levied have been nominal.

British Columbia Health Minister Adrian Dix is pictured in New Westminster, B.C., on March 31, 2018.

DARRYL DYCK/The Canadian Press

Across the country, a physician or clinic engages in extra billing when additional charges are made to patients for procedures that are otherwise paid for by the public system.

The measures announced Wednesday by B.C. Health Minister Adrian Dix won applause from public health-care advocates, who say the province is taking long-overdue action to curtail the expansion of a two-tier health-care system.

However, Brian Day, a leading private health-care proponent fighting the B.C. government’s efforts to shut down his two private-pay facilities, described the changes as “draconian.”

Dr. Day predicted they will lead to the closing of many of the province’s 56 private surgical facilities and 17 private MRI facilities - forcing tens of thousands of patients back into the public system and making waiting times even worse.

“What will haunt them is that patients waiting for other procedures will be swept aside – children, people with cancer. … These people will suffer longer wait lists,” he said in an interview. “A large percentage of the clinics in B.C. will close if this goes through.”

By cabinet order, B.C. is enacting a law that was introduced by the former BC Liberal government 15 years ago, and never fully brought into force. That law provides tougher penalties − starting at $10,000 for a first offence − and greater powers of investigation by the provincial Medical Services Commission into complaints of extra billing. As well, it ensures patients will not be liable for extra billings.

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Dr. Day is medical director of Vancouver’s Cambie Surgery Centre, and has waged a decade-long legal battle that contends patients should have the right to pay for quicker treatment in private clinics. The B.C. Supreme Court trial on Dr. Day’s constitutional challenge resumes next week, and he said he will be consulting his lawyers to determine if they can apply for an injunction against the cabinet order until the trial is concluded.

Mr. Dix told reporters he is not seeking to close private clinics, but to ensure that they operate within the law.

He said the provisions “guarantee fair access to surgery by ensuring that people cannot buy priority access by getting private procedures … [and] jumping ahead of others waiting in line for publicly funded surgeries.”

The changes do not stop the current practice of health authorities partnering with private providers or private clinics − as long as the services are publicly funded, and patients are not required to pay out of pocket. As well, these changes do not prevent patients from choosing to pay for services, such as cosmetic procedures, that are not medically necessary.

Mr. Dix added that the new regulatory regime is just part of the equation. He noted that the province has allowed a private-care system to thrive because the public health-care system has been starved for resources.

“It’s the government’s responsibility to strengthen the system and focus on improvements to prevent the need for a parallel system where people feel the need to buy their way to the front of the line.”

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In the past two weeks, the provincial government has announced measures to address health-care pressures, with new funds to reduce surgical waiting lists and to provide more diagnostic services.

“This is a significant moment for health care in B.C.,” said Edith MacHattie, BC Health Coalition co-chair. “Patients have been taken advantage of, and these significant steps are long overdue.”

Federal Minister of Health Ginette Petitpas Taylor welcomed the announcement and said B.C. may now be eligible to recoup the penalty that Ottawa levied against the province this year for allowing extra billing.

“We want to make sure we don’t have a two-tier health-care system in Canada,” Ms. Petitpas Taylor said in an interview.

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