RAMQ fails to rein in overbilling

The Régie de l’assurance-maladie QUEBEC is dragging its feet in checking up on the billing practices of the province’s 21,000 doctors, even though RAMQ billing cost taxpayers $7.7 billion in 2017-2018. Errors and overbilling continue to plague the system. And the province is once again swimming in used tires of all kinds while the recycling agency in charge of finding new uses for them has been a dismal failure at finding new uses for them. The province’s auditor-general, Guylaine Leclerc, sounded the alarm on the two issues in a hard-hitting report tabled Friday in the National Assembly. After strongly criticizing the RAMQ three years ago for only checking about two per cent of the medical actions doctors have been billing, things have improved a little with 13.5 per cent of bills now being checked, Leclerc said. But there’s still room for improvement, she said. She noted that as part of her audit the RAMQ had a closer look at the billing practices of 184 doctors who charge the RAMQ more than $1 million a year. With one series of checks, it hauled back $10 million in overpayments. The salaries of 25 of the best paid doctors in Quebec were examined in detail only to discover they had claimed a total of $3 million in charges that were not justified, the audit concluded. Leclerc said while the RAMQ has put in place checks on the billing of individual medical acts, there is other compensation and incentives — such as charging RAMQ extra for work in an emergency ward on the weekends or legal holiday — where things are still far too slipshod. Those other actions represent about 30 per cent of the $7.7 billion handed to doctors in 2017-2018. Leclerc said she is not convinced the problem is solved completely and doctors are clean as a whistle. “The controls put in place do not yet provide a reasonable assurance that the payments are in accordance with the agreements and reflect the actual work performance,” she writes. At a news conference following her presentation, Leclerc was asked whether the “party” was over for some doctors who took advantage of the lack of supervision in the past. “We started from a long way out,” Leclerc said. “In the past the only risks the RAMQ took seriously were those posed by patients who were breaking the rules. Now there are rules for billing fees for service but there are still steps to be taken.”

NOT ENOUGH USES FOR RECYCLED TIRES

Twenty-five years after the devastating fire in St-Amable, in which 4 million tires went up in smoke, the stockpile of tires, tire shavings and rubber is soaring because there are not enough uses for the material. The total provincial stockpile has doubled from 15,400 tonnes in 2014 to 33,400 tonnes in 2016, the auditor reveals. Car-loving Quebecers — there are 5.2 million vehicles on the road — purchased a total of 8.7 million tires last year. The agency in charge of handling the afterlife of those tires, Recyc-Québec, is struggling, with the auditor saying the agency lacks imagination and a sense of initiative with a management philosophy that is “reactive rather than proactive.” Although much of the media attention in the last few months has been on the drop of worldwide demand for household recycling products, the problem of what to do with all those tires is real, Leclerc notes. “Recyc-Québec does not properly play its role in supporting innovation and the development of new products derived from endof-life tires in the remoulding and recycling industry,” Leclerc wrote. “Instead it leaves it up to its partners to take action.” Even though there 12,000 retailers selling tires, Recyc- Québec has only one inspector to keep tabs on what’s happening to those tires. While 10 years ago there were 10 companies in Quebec recycling tires, the number has dropped to four, which limits competition. Leclerc said Quebec can do better. At the same time, Recyc- Québec continues to live off the subsidy it collects in the form of $3 per tire sold in Quebec, about $25 million in all. “After 20 years of financial aide, is it normal that recyclers still need subsidies?” the auditor asks in her report. Reaction to the report was swift, with Recyc-Québec saying in a statement it intends to follow up on all of the auditor’s suggestions. “We are committing today to pursue the optimizations (of the material) suggested,” said Recyc- Québec president Sonia Gagné, noting they are supporting financially five research projects looking for other ways to use the tire remains. But Parti Québécois opposition critic for the environment Sylvain Gaudreault was not impressed. “There’s something shocking and insulting in all this,” Gaudreault said. “It’s like Recyc- Québec is just sitting there, not on its laurels but on a big pile of tires, saying things will roll along normally.”