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The B.C. Medical Services Commission ordered two private Vancouver clinics to stop extra-billing their patients after an audit found they were charging clients for services covered by the province's Medical Services Plan.

The medical director of both clinics is Brian Day, past president of the Canadian Medical Association. He said the audit is a waste of money because his business has never hidden how it operates.

"Why do you need to go through this process of spending two years auditing a clinic to find out something they freely admit they do?" Dr. Day said. He insisted restricting access to health care is unconstitutional.

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As the clinics continue to fight the constitutionality of the prohibition against extra-billing, the provincial government is refusing to be drawn into the debate, even as the government-affiliated commission takes on perceived extra-billers.

"That's why we have the courts," said B.C. Minister of Health Michael de Jong. "That is the appropriate venue for those arguments to be heard."

The nine-person commission manages the Medical Services Plan on behalf of the province. The Medicare Protection Act gives the commission independent authority and responsibility for enforcing the provisions within the act, Mr. de Jong said.

Sections 17 and 18 of the act prohibit billing patients for publicly insured medical services.

The commission decided to start an audit of Cambie Surgeries Corporation and the Specialist Referral Clinic Inc. – which have the same owners – more than four years ago, said Stephen May, a senior public affairs officer for the Ministry of Health. The decision came after the commission received numerous private complaints from the clinics' clients about extra-billing. Some complaints predated the commission's ability to audit clinics, which came in 2006 after the government modified the act, said Thomas Vincent, the commission chair.

About 10 months after the decision to audit, the Canadian Independent Medical Clinics Association and six private surgical centres filed a constitutional challenge in the Supreme Court of B.C. over the commission's authority to prohibit extra-billing. After a counterclaim and appeal, the B.C. Court of Appeal ruled in favour of the Medical Services Commission and the two parties agreed to proceed with the audit – despite the constitutional challenge still being in the courts, Mr. May said.

The commission's audit found the two clinics violated the act by extra-billing their clients, Mr. Vincent said. The audit discovered more than 200 such cases for services accounting for nearly $500,000.

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The commission has ordered the clinics to stop this practice within the next 30 days, Mr. Vincent said. If they do not comply, the commission will seek a court-ordered injunction.

If the clinics were to violate a court-ordered injunction, the court – not the commission – would take further action, he said. But it would be based on the commission being able to produce evidence of the practice continuing, Mr. Vincent said.

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