Doctors' billing out of control, Quebec auditor general concludes

Quebec has lost control of costs related to doctors' billings, spending $416 million more than it budgeted to pay physicians over the past five years, the provincial auditor general said in her report, released Friday.

Guylaine Leclerc said between 2010 and 2015, specialists billed the province $384 million more than it had budgeted for, while general practitioners billed $32.7 million more than what Quebec had expected to pay them.

This year, spending on physicians' fees for service and salaries is expected to hit $7 billion.

Few audits to detect fraud, errors

Leclerc also said the provincial public health insurance agency, RAMQ, doesn't do enough to try to detect fraud or billing errors – even though physicians' remuneration amounts to 62 per cent of RAMQ's expenses.

She said of Quebec's 17,542 physicians, only two per cent have had their billings audited, and in most cases, that was for a single act or procedure.  Physicians bill RAMQ for 55 million acts annually.

The auditor general said the process to verify whether a doctor has actually performed an act that he or she has billed for is not effective enough. Leclerc believes this leaves the whole system vulnerable to error or fraud.

The lack of control over doctors' remuneration is hurting the entire health care system, Leclerc concludes. The surplus spending – unbudgeted for, and therefore never approved by the Quebec Treasury Board – means the money has to come from elsewhere in the system.

Reaction to report

The Quebec Federation of Medical Specialists said that it respects the auditor general's report but believes it only looks at part of the picture.

"The auditor general cannot conclude that the government has not saved money in the end because it was not the objective...An approach based strictly on an accounting analysis remains fragmented and needs to be put into perspective since, in the end, too many elements are not considered," the federation said in a statement.

"This overspending was used for services to the population. In reality, this excess reflects our increased productivity."

The federation said if it becomes necessary to re-evaluate the way doctors are paid, it is prepared to participate in the exercise.

Quebec Health Minister Gaétan Barrette said that while the audit found that doctors billed $416 million more than the province budgeted for, this won't happen again in the future.

Barrette says budget projections are now more accurate.

"We are not making those predictions the same way -- not based on hypothesis. It's based on the actual numbers that we see on an annual or semestrial basis. So what we've seen in the past five years will not happen because we have changed the methodology," Barette said.

Opposition MNAs criticized the Liberal government after the auditor general's report was released.

"The report confirms that the Liberal government offers the doctors gift after gift, while not gaining any improvements in access to care," said a statement released by the Parti Québécois.

"There are no savings for the government, no better access for patients, but there is $416 million more for doctors," said PQ health critic Diane Lamarre.

Coalition Avenir Québec is calling for a change in the remuneration system.

"With the current remuneration model, the more medical procedures a doctor carries out, the more he is paid. It's mathematics!" said the CAQ in a press release. "If a doctor does more treatments, that's fine, but it cannot be the cause of nasty fiscal surprises," a statement from the CAQ said.