$13M clawed back from transfers to Alberta as clinics fall under scrutiny

Health Canada says charges for medically necessary diagnostic services led to Alberta being deducted $13 million in transfer payments earlier this year.

Under the Canada Health Act, provinces that allow private health-care providers to charge patients for medically necessary services have dollars clawed back by the federal government. 

According to Health Canada, Alberta was subject to a $13,781,152 deduction to its Canada Health Transfer payment in March 2023 under the Diagnostic Services Policy in relation to patient charges to access diagnostic services such as MRIs and CTs. 

Two other provinces saw higher deductions under the policy in March. Quebec saw $41,867,224 deducted, while British Columbia saw $17,165,309 deducted.

The press secretary for Alberta's health ministry said the province has a robust audit system to ensure there are no extra billing or user charge issues.  

"This is why we don't agree with the findings of the federal government," Scott Johnston wrote in an email to CBC News. 

"The Government of Alberta will work with the federal government on addressing this issue and ensuring Alberta receives the full Canada Health Transfer payment that it is entitled to."

The figure comes as Health Canada says it is aware of an arrangement at another clinic in Calgary that could run afoul of the Canada Health Act under that policy.

The Harrison Healthcare clinic had been flagged by the Alberta NDP on Wednesday as part of their call for a probe into the possibility that "members-only medicine" was being practised in several clinics across Alberta. 

In a statement to CBC News, Health Canada said the Harrison Healthcare clinic, which has locations in Calgary and Vancouver, provides a mix of insured and uninsured services.

"From the Harrison website, it indicates that they do not offer MRI or CT scans, but partner with a third-party private clinic to provide these services," Health Canada spokesperson Anne Genier wrote in a statement.

Heatlh Canada added that Harrison's website states that a "subscription to a Harrison program or service is not a precondition to access insured services." 

However, it adds that if a physician determines a diagnostic imaging service is medically necessary, the clinic partners with a third-party provider of private MRIs and CTs, which provides faster access than may be received in the publicly-funded system.

"It is these private clinics offering medically necessary diagnostic scans for which Alberta took Canada Health Transfer deductions in March 2023," the statement reads.

Harrison Healthcare was founded and is chaired by Don Copeman.

In an email to CBC News, Copeman said, "We have always been open and transparent with government and have worked tirelessly on legislative compliance over the past 18 years, which has been validated. We will not be commenting further." 

Follows Marda Loop clinic charging membership fees

Fiona Clement, a professor at the University of Calgary in the department of community health sciences, said the issue is the same as what previously arose at the Marda Loop Medical Clinic earlier this week.

That clinic sent a message to clients last week stating it would move to a membership system and charge costs up to $4,800 for families.

Health Canada pushed back against the Marda Loop clinic's plans, and Premier Danielle Smith and Alberta Health Minister Adriana LaGrange said they had directed Alberta Health to investigate it. 

Speaking at an unrelated press conference on Friday, Smith noted her government had signed an agreement with Ottawa worth $24 billion over 10 years to uphold the principles of the Canada Health Act.

"That means that you cannot charge to access insured services. If that's what [Marda Loop is] doing, they will be shut down, they will be fined, [or] we will withhold payments to them. So it won't be allowed to happen," Smith said.

Still, Clement said the same issues were arising at clinics like Harrison Healthcare. 

"You can't charge for quicker access and you can't charge for medically necessary care that is publicly funded," Clement wrote in an email. 

"The feds are not going to turn a blind eye to any slippage in the Canada Health Act, and they are prepared to take action in terms of clawbacks of funding."

Clement said the situation as described at Harrison posed some logical roadblocks when it comes to preferential access.

"If the MRI is medically necessary, you can't charge for it. If it isn't medically necessary, you can charge, but then why are you doing it?" she said. "Similarly, if it is medically necessary, the patient needs to join the queue and wait. You can't charge for preferential access.

"So, you could charge for a service where an administrative person at Harrison's makes the call to book your appointment so you don't have to."

On Friday, a spokesperson for with the provincial health ministry said they will continue to work with all providers to ensure compliance with the Canada Health Act.

"Our goal is to stabilize and strengthen primary health care across the province so everyone has access to a primary health care provider, no matter where they live," Johnston wrote in an email.

Johnston reiterated that Alberta Health is not aware of any clinics besides Marda Loop offering services for a membership fee that do not align with current legislation.

'Canaries in a coal mine'

Jim Dickinson, a professor in the department of family medicine and community health sciences at the University of Calgary, said what was unfolding is becoming a crisis.

"[Marda Loop] is the canary in the coal mine. Well, actually, there are several canaries in the coal mine," Dickinson said.

"Really, all of these are just a sign of the overall system problems, which is the underfunding of family medicine. And until something is done, very substantial, about improving the way we pay for and organize family medicine, then there is just going to be more of this."

On Wednesday, the provincial government said there were 13 known clinics operating in Alberta that fall into the category of offering uninsured services that are outside of the Canada Health Act and the health-care insurance plan.

"As for other clinics that Alberta Health is aware of, the audit and compliance unit has evaluated instances where private clinics operate and provide services that are outside of the Canada Health Act in Alberta (uninsured services). All evaluations done to date have confirmed that these clinics are operating in compliance with the act," wrote Johnston, a spokesperson with the health ministry.

Dickinson called that a "narrow, technical legal view."

"These people have found ways of treading just inside the line," he said. "And there will be more, because that's necessary."

System under stress

Janice MacKinnon is a professor of public policy at the University of Saskatchewan and a former Saskatchewan finance minister, whose recommendations were utilized by the UCP under former premier Jason Kenney. 

She said what's unfolded at the Marda Loop Medical Centre reveals the extent to which Canada's health-care system is under stress.

"You have patients that are not willing to wait and are looking for other options," she said in an interview.

"And, you have doctors and other health professionals that are really stressed about the fee-for-service model, with patients, patients, patients, with not adequate time to really deal, in some cases, with the problems."

The other issue, in MacKinnon's view, is that the idea of paying money to get preferred access to health care is "based on the myth about Canada — that in Canada, health care, solidarity, means everybody waiting in line together."

"But that has never occurred. And increasingly, it's occurring less and less. People have always said, 'Look, I'm taking my money. And if my province doesn't let me pay for service here, I'm going to another province or another country, and then paying for the service,'" she said.

Dr. Alika Lafontaine, president of the Canadian Medical Association, previously told CBC News that providing different levels of access to health services based on ability to pay can negatively impact patients who are in greatest need of care — but added that pay-out-of-pocket approaches have become more prevalent as public health systems deteriorate nationwide.

"Lack of investment, outdated incentives, and unhealthy working environments must be improved if we're to have providers remain committed [to] our public health systems and to ensure that delivery provides adequate access to needed health services," Lafontaine wrote in a statement.