Clinics’ user fees facing crackdown
After years of playing a largely passive role, Quebec’s medicare board is now taking an aggressive approach in cracking down on private clinics that charge patients illegal user fees.
In one of its biggest investigations to date, the Régie de l’assurance-maladie du Québec concluded this month that the Rockland MD surgical centre in Town of Mount Royal has illegally charged patients fees in the thousands of dollars for services that are supposed to be fully covered under medicare.
Doctors at Rockland MD practise under the public system, billing RAMQ for medical procedures they perform on patients.
At the same time, Rockland MD charged these same patients a wide range of fees, including a package deal called “Forfait Santé” that can run as high as $18,750, according to RAMQ.
Among the services charged to patients are “nursing accompaniment” during an operation, “teaching services” and a post-operative follow-up phone call.
All these fees, RAMQ contends, contravene the provincial medicare law.
RAMQ noted that paying for the “Forfait Santé” is mandatory for patients at the clinic to receive services that are normally fully covered under medicare.
RAMQ is seeking at least $73,000 in fees that Rockland MD charged patients, based on the findings of eight patients. That amount could rise if more patients come forward.
Dr. Fernand Taras, medical director of Rockland MD and the majority shareholder, defended his clinic’s fees in an interview with The Gazette on Friday, saying he disagrees with RAMQ’S interpretation of the law.
“What has happened is that with the change of (health ministers from Philippe Couillard to Yves) Bolduc, they didn’t get to the point where they negotiated a fee that would allow us to cover the expenses of the nurse, the OR and the infrastructure,” Taras said.
He added RAMQ is “an insurance company”that doesn’t understand the law gives him the right to charge these fees at his surgical centre.
When informed the l aw does not allow doctors taking part in the public system to bill patients for nursing care, Taras grew increasingly agitated, shouting at the reporter over the phone, saying: “I will sue your guts.”
The turn around in ramq’s approach has come amid a proliferation of private surgical clinics in the province as well as increased news coverage.
Quebec also changed the law governing RAMQ to permit it to launch investigations on its own initiative – rather than act on complaints by patients – following a Gazette exposé on private health care in 2005.
In 2010, RAMQ agreed to reimburse patients who paid illegal fees a total of $829,607 – double the previous year.
At present, RAMQ is continuing investigations into allegations of illegal user charges at the following clinics: Plexo, Medisys, Physimed and a centre in Blainville, said RAMQ official Claude Morin.