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British Columbia targets private health care with new penalties for extra billing

The British Columbia government is enacting a law that aims to ban extra billing by doctors, in its first major swipe in the province’s long-running battle with the expansion of private medical care.

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

Those findings were recently confirmed in a series of audits conducted jointly by the federal and B.C. governments which led to the first significant fine against the province in March — $15.9-million — for violations of the Canada Health Act. That amount was for just three clinics audited, in the fiscal year of 2015-16. There are 56 private surgical facilities and 17 private MRI facilities currently operating in the province.

“This is the end of ‘don’t ask, don’t tell,’” Health Minister Adrian Dix said Wednesday. He said the goal is not to shut down the province’s private medical clinics, but his government will not tacitly ignore the well-known practice of unlawful extra billing.

“Medicare is protected by law … It’s our expectation that those who provide health care in B.C. follow the law.”

In recent weeks, the provincial government has announced measures to address the health care pressures that are driving patients to seek costly private care, with new funds to reduce wait lists and provide more diagnostic services. Mr. Dix said B.C. is well below the national average for providing those services – a factor that is driving B.C. patients to private care options.

Extra billing means fees that patients are billed for procedures that are paid for by the public system, but for which a physician or clinic adds additional fees.

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

It will bring B.C. into line with other provinces. In Ontario, access to insured services and “queue jumping“ for an insured benefit is protected under provincial legislation, and in Alberta, no physician or dentist who is opted into the Alberta Health Care Insurance Plan and provides insured services can charge amounts above insured services.

Mr. Dix noted that B.C. is the only province that has been fined by Ottawa every year since 2001 for violations of the Canada Health Act. But he said the $15.9-million fine is by far the largest – and he hopes Ottawa will refund that amount when its sees the province’s new measures to tackle the issue.

The Globe investigation found that regulators were doing little to stop doctor-owned clinics from quietly making desperate patients open their wallets to bypass long lines for everything from simple appointments to major surgery.

In response, the federal government vowed to apply pressure to the provinces – especially British Columbia, where extra billing is most prevalent – to investigate doctor and clinic billings further.

B.C.’s New Democrats, which formed government just weeks after the Globe’s findings were published, blamed the former BC Liberal government for turning a blind eye to extra billing.

Two weeks ago, B.C. Premier John Horgan announced a $75-million investment to reduce long wait lists for hip and knee replacements, allowing an extra 4,000 people to have the surgeries in the coming year. And last week, Mr. Dix promised more resources for magnetic resonance imaging, or MRI, exams, with a goal to provide 37,000 more exams by the end of March 2019, compared to the previous year.

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