Health crackdown on doctor double-billing hindered by privacy laws

New Brunswick's health department says privacy rules have prevented it from cracking down on doctors who double-bill medicare and WorkSafe New Brunswick for the same services.

The department's deputy minister told a committee of MLAs Wednesday that privacy legislation makes it impossible for the two government bodies to compare notes and figure out if they're paying for the same service twice.

"One of the challenges we have with the data is you cannot use the data for something other than what the data was collected for," Tom Maston told the public accounts committee.

"Each act will specify that this piece of data is collected for this reason, and if you want to use it for a different reason, sometimes the act will not permit that. Even within our department, within divisions, it is difficult to share data because of privacy concerns."

Double-billing in 2012

In her 2012 report, AuditorGenenal Kim MacPherson recommended new legislation and policies to get doctor overbilling under control.

Her audit found 16 doctors billed medicare for more than $1 million, which was double what the health care budget expects per doctor.

She also found some doctors used by Worksafe NB were billing that agency and medicare for the same service. She recommended improving and automating the system for Worksafe claims to catch double-billing.

Opposition Progressive Conservative MLAMadeleineDub, who was the health minister at the time, called the issue "abiggie," butMastonadmitted there's little that can be done because of privacy legislation.

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"At the current time this one has gone as far as it can go," he said. "It is one that we would like to pursue again but there are administrative challenges to that one. the ability to share information between organizations."

Expensive fix

The issue has come up elsewhere in the government, he added, but it would take a major overhaul to privacy legislation to fix it.

"It's one that's under active discussion but the ultimate solution would be a pretty extensive legislative approach," he said.

Dube said there are "probably savings there" if the department can save a few million dollars and spend it elsewhere.

"There are some efficiencies still to be found in the system, and that will help you, the department, the government, to continue to provide services."

I don't think we've done it since and that would be an oversight we need to address.- Tom Maston, deputy minister of health

In her 2012 report, MacPherson also urged the health department to report publicly on how much money it was recouping by going after doctors who overbill.

Maston acknowledged Wednesday that after doing that once, in its 2012-13 annual report, "I don't think we've done it since and that would be an oversight we need to address."

Maston said the department didn't follow MacPherson's recommendation to draft new legislation because it wasn't needed. Findings by the existing audit system are enforceable in court, he said.

New monitoring program

He said the department brought in new monitoring for radiologists, an area where the auditorgeneral found five cases of $1 million in billings and where she said there was no oversight.

"That's now complete across the province," Maston said.

At the time of MacPherson's audit, the New Brunswick Medical Society blamed the overbilling not on doctors but on poor billing software.

Last year, the Liberal government passed legislation that would allow the billings by individual doctors to become public.

A spokesperson for the health department said Wednesday "Afinal determination has not yet been made" about whether the numbers will be released. While the new law allows it, "it does not make it mandatory," she said.