Quebec doctors use loophole to sidestep new law banning extra fees

Some Quebec doctors are using a loophole in the province's medical insurance regulations, in an apparent bid to get around a new law banning private clinics from charging userfees.

CBC News has learned at least two private clinics have told patients to find a registered company that could be billed for their procedures operations covered by Quebec's medical insurance board, RAMQ,and performed by doctors who are enrolledin the public system.

The patient was then expected to reimburse the registered company.

The law abolishing so-called auxiliaryfees goes into effect on Thursday.

Quebec Health Minister Gatan Barrettehas lockedhorns with Quebec's federation of medical specialists (FMSQ), whichaccuses Barretteof pushing the law through without any formal agreement on how the specialistswill be reimbursed for extra costs that they incur.

'Any company will do,' patient told

One patient, whose name we've agreed to withhold, said in early Januaryshe went for a surgical consultation at Rockland MD, a private clinic in the Montreal area.

"They told me that the law [banning accessory fees] was coming into effect Jan.26, and therefore, I myself could not pay them," she told CBC.

The patient, who is retired, said she was told,"I would have to find a company:an electrician, a plumber, a hairdresser, who would agree to pay the clinic, and then I would reimburse the company."

She was confused and shocked bythe suggestion, particularly since she had been to the clinic a few years earlierfor the same procedure.

I asked, 'Can it be any company? Can it be my plumber? Can it be my electrician?' And they saidas long as it's a registered company, any company will do.- Rockland MD surgical patient

At that time, she had paid for her own surgeryand had received a bill to that effect.

"I asked very blatantly, 'Is this legal?' And they said, 'Ohyes, it is," she told CBC, adding that the nurse's tone was casual and matter of fact.

"I asked, 'Can it be any company? Can it be my plumber? Can it be my electrician?' And they saidas long as it's a registered company, any company will do."

Clinic says 3rd-party billing islegal

A doctor at anotherclinic also confirmed to CBC that he regularly tells patients that companies are able to pay the entire cost of their procedures in the privatesystem a practice which he said is perfectly legal.

When pressed, that doctoradmitted he doesn't verify if the patient is an employee of the company that is billed.

CBC News made repeated attempts to get an explanationfrom RocklandMD about the practice described by the clinic's patient.

When asked to explain it, Janice Labelle, who we were told wasresponsible for public and business relations at Rockland MD,told CBC, "There's no response, really. It's just the law. You can look it up at RAMQ."

A public relations consultant for the clinic, AnnickMongeau, later contacted CBC, saying Labellehad not been authorized to speak to the media.

Mongeau said the patient must have misunderstood what she was told, explainingthat Rockland MD asks for further documentation after the surgery is booked, to prove that the patient is actually an employee of the business payingfor the procedure.

"This is a very unfortunate misunderstanding," said Dr. Fernand Taras, the clinic's medical director."The law is very clear and we abide by the law. What we tell patients follows what's spelled out in the law."

Taras also said Rockland MD is committed to ensuring, from now on,that staff explain the practice more fully to prospective patients.

Legal or not?

Article 22 (i) of Quebec's Regulation on the Application of the Medical Insurance Law stipulates that an employer or association is allowed to pay for the medical services of an employee.

"It was written into the lawto avoid paying for disability longer and to get people back into the workforce faster," explained Amlie Quesnel-Valle, a McGill professor who specializes in health policy.

They are recommending that their patients engage in illegal activities, essentially.- McGillProf.AmlieQuesnel-Valle, health policy specialist

However, Quesnel-Vallesaid, in using the loophole without verifying if the patients are employed by the billed company, she believes doctors are "violating the principle of the law."

"It's there for when you need it, but they shouldn't be encouraging patients to go and get this loophole," said Quesnel-Valle.

"They are recommending that their patients engage in illegal activities, essentially."

The FMSQ said it doesn't have enough information about these two cases to determine whether the doctors are respecting the law or not. However,the federationspecified it does notcondone any strategy that blocks services for people covered by medicare.

Quebec's medical insurance board, RAMQ, told CBC that it couldn't comment specifically on anything relating to Rockland MD, becausethe government agency is currently suing the clinic over alleged illegal billing.

But RAMQ'sspokesperson said, in general, doctors aren't allowed to tell patients to find any registered companyand ask them to be billed for services provided.

The patient needs to be employed by the company that pays for private medical services, the spokesperson said.

The health insurance boardinvites any Quebecerwho has been asked to pay forhealth services through a third party who is not that person's employer to contact RAMQ, so it can investigate.