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B.C.'s NDP opposition says Christy Clark’s Liberal government has tacitly allowed significant unlawful extra billing by doctors through private clinics because of weak regulation.Ben Nelms/The Globe and Mail

B.C. doctors have been forced to repay more than $21-million in fees over the past five years based on public complaints about inappropriate billing to the province's medical-services plan.

The Ministry of Health provided the figures to underscore its efforts to rein in illegal billing by physicians after an investigation by The Globe and Mail into double-billing found the practice is most prevalent in British Columbia, where 30 private surgical and diagnostic clinics – the largest number of any province – are charging patients for access to everything from medical appointments to operations.

The province has done 135 audits since 2012 under its Billing Integrity Program, leading to the recovered payments. The audits look at concerns ranging from extra billing to claims for services not rendered.

Premier Christy Clark says her government has been serious about upholding the Canada Health Act and is prepared to do more to protect the public health-care system.

She said her former health minister – who was replaced in a cabinet shuffle on Monday – "has been doing a lot of work … making sure that we are doing the audits that are required." She said the government is ready to beef up those audits if necessary.

However, the NDP opposition says Ms. Clark's BC Liberal government has tacitly allowed significant unlawful extra billing by doctors through private clinics because of weak regulation.

Judy Darcy, the NDP spokesperson for health, said B.C. has become the "Wild West" in private health care because the governing Liberals have largely turned a blind eye to extra billing.

"The Liberals have allowed this private health care to flourish so the wealthy can jump the queue, and that's wrong," Ms. Darcy said in an interview.

"This government has – at best – done spotty, occasional audits of the practices of double-billing."

B.C. is the only province the federal government has fined every year of the past five – approximately $1-million in total – for allowing extra-billing in violation of the Canada Health Act.

Federal Health Minister Jane Philpott has promised her officials will put more pressure on the provinces – particularly B.C. – to investigate doctor and clinic billings further.

The NDP is hoping to form a government in B.C. after a vote of confidence that could come later this month and bring down the governing BC Liberals.

Ms. Darcy said an NDP government would shorten waiting lists in the public-sector health-care system by maximizing the use of operating rooms and diagnostic equipment.

That effort aims to address one reason British Columbians are more likely to pay out of pocket for medical services: long waits for procedures such as hip and knee replacements and cataract surgery.

As well, she said, an NDP government would strengthen the regulatory regime to put up meaningful barriers against double-billing by doctors.

"We've only seen the tip of the iceberg of what is going on," Ms. Darcy said.

Ms. Darcy said The Globe investigation into double-billing has exposed a greater problem than the provincial government was willing to acknowledge. "This story has revealed the problem to a far greater extent than we have been able to get from the minister. Christy Clark's government has turned a blind eye when we called for systematic audits, and under their watch, private clinics have expanded dramatically."

She said the NDP would tackle private clinics by expanding access to the public system. "There are operating rooms that sit idle, MRIs that sit idle for many hours of the day. We need to invest in innovation to use our capacity to the maximum. … The goal is to have more people being served faster and better in the public system and to reduce two-tier health care, which is flourishing in British Columbia."

The prime minister says all levels of government must continue to push for 'lasting solutions' to the rising opioid epidemic in Canada. Justin Trudeau addressed the Federation of Canadian Municipalities Friday in Ottawa.

The Canadian Press