A small group of cardiologists at two Lower Mainland hospitals were compensated over the past six years for procedures they did not perform, according to an internal investigation.
But those payments amounted to about $1-million, not the $4-million alleged by an anonymous complainant last year, and may have been offset by the doctors performing more complex, time-consuming procedures for which they were not adequately compensated, the investigation concluded.
It is not clear whether either of the two health authorities involved suffered an overall financial loss as a result of the fees, the investigation found.
The investigation was triggered by an anonymous letter in June, 2015, that alleged a small group of cardiologists at St. Paul's and Vancouver General hospitals had charged the two facilities almost $4-million for procedures they did not actually perform. Its report, dated Aug. 17, 2015, was obtained by The Globe and Mail through a freedom of information request.
The anonymous complaint did not say over what time period those payments had been made. But it cited a 2012 report that flagged the issue of "unanticipated procedural fees" being paid for some procedures and recommended those fees be eliminated.
The letter – which was also sent to The Globe – concerns a widely used procedure known as a transesophageal echocardiogram, or TEE, which involves inserting a probe into the esophagus to monitor a patient during heart surgery. TEEs used to be done primarily by echocardiographers. But over about the past decade, more cardiac anesthetists have been trained in the procedure According to the complaint, anesthetists now routinely perform the procedure as part of overall patient care.
However, the complainant alleged, "a few cardiologists who may or may not even be in the hospital at the time of the procedures have been charging the hospitals for years a procedural fee ... for performing as many as 10 per day of the above procedures without actually performing or even being present for any of them as required by the billing code."
That practice had resulted in the small group of doctors charging the hospitals almost $4-million for performing procedures they never did, the complainant alleged.
The anonymous complaint set off an investigation that found administrators had been aware of TEE payment concerns even before the 2012 review, but that efforts to tackle the issue had stalled – in part because specialists considered TEE procedural fees as compensation for other "offset procedures" they might perform during heart surgery.
"While there are no formal agreements or clear communication to support current practice, it appears that there was implied agreement that the incorrect payment for TEEs would continue as offset in recognition that the echocardiographers perform other procedures that they are not adequately funded for," the investigation found. It was carried out by Internal Audit Services, the audit division for four of B.C.'s health authorities.
Investigators found that cardiographers do not submit invoices for the procedures but that "fee codes" are automatically applied as part of a broader billing system. As part of that system, expenses are reviewed, but the documentation provided in that process "lacks sufficient information to be able to provide meaningful oversight," the investigation found.
A tangle of billing and information management systems made it difficult for investigators to sort out how many TEEs had been performed and by whom.
But after reviewing available records, IAS found TEE fees over the past six years amounted to about $630,000 at St. Paul's and $441,000 at Vancouver General Hospital, or about $1-million – far less than the $4-million mentioned in the anonymous letter.
Since the complaint was received last year, both hospitals have stopped paying the procedural fees.
In its report, IAS made four "improvement observations," including that management at Providence Health Care, which runs St. Paul's, and Vancouver Coastal Health, which operates Vancouver General, meet with echocardiography groups at both sites to negotiate appropriate rates, "while ensuring that they are not compensated for procedures they do not perform."
Investigators did not recommend disciplinary action against any of the doctors involved in the probe.