Quebec doctors use loophole to sidestep new law banning extra fees

Some Quebec doctors are using a loophole in the province's medical insurance regulations, in an apparent bid to get around a new law banning private clinics from charging user fees.

CBC News has learned at least two private clinics have told patients to find a registered company that could be billed for their procedures — operations covered by Quebec's medical insurance board, RAMQ, and performed by doctors who are enrolled in the public system.

The patient was then expected to reimburse the registered company.

The law abolishing so-called auxiliary fees goes into effect on Thursday.

Quebec Health Minister Gaétan Barrette has locked horns with Quebec's federation of medical specialists (FMSQ), which accuses Barrette of pushing the law through without any formal agreement on how the specialists will be reimbursed for extra costs that they incur.

'Any company will do,' patient told

One patient, whose name we've agreed to withhold, said in early January she went for a surgical consultation at Rockland MD, a private clinic in the Montreal area.

"They told me that the law [banning accessory fees] was coming into effect Jan. 26, and therefore, I myself could not pay them," she told CBC.

The patient, who is retired, said she was told, "I would have to find a company: an electrician, a plumber, a hairdresser, who would agree to pay the clinic, and then I would reimburse the company."

She was confused and shocked by the suggestion, particularly since she had been to the clinic a few years earlier for the same procedure.

I asked, 'Can it be any company? Can it be my plumber? Can it be my electrician?' And they said as long as it's a registered company, any company will do.- Rockland MD surgical patient

At that time, she had paid for her own surgery and had received a bill to that effect.

"I asked very blatantly, 'Is this legal?' And they said, 'Oh yes, it is," she told CBC, adding that the nurse's tone was casual and matter of fact.

"I asked, 'Can it be any company? Can it be my plumber? Can it be my electrician?' And they said as long as it's a registered company, any company will do."

Clinic says 3rd-party billing is legal

A doctor at another clinic also confirmed to CBC that he regularly tells patients that companies are able to pay the entire cost of their procedures in the private system — a practice which he said is perfectly legal.

When pressed, that doctor admitted he doesn't verify if the patient is an employee of the company that is billed. 

CBC News made repeated attempts to get an explanation from Rockland MD about the practice described by the clinic's patient.

When asked to explain it, Janice Labelle, who we were told was responsible for public and business relations at Rockland MD, told CBC, "There's no response, really. It's just the law. You can look it up at RAMQ."

A public relations consultant for the clinic, Annick Mongeau, later contacted CBC, saying Labelle had not been authorized to speak to the media.  

Mongeau said the patient must have misunderstood what she was told, explaining that Rockland MD asks for further documentation after the surgery is booked, to prove that the patient is actually an employee of the business paying for the procedure.

"This is a very unfortunate misunderstanding," said Dr. Fernand Taras, the clinic's medical director. "The law is very clear and we abide by the law. What we tell patients follows what's spelled out in the law."

Taras also said Rockland MD is committed to ensuring, from now on, that staff explain the practice more fully to prospective patients.

Legal or not? 

Article 22 (i) of Quebec's Regulation on the Application of the Medical Insurance Law stipulates that an employer or association is allowed to pay for the medical services of an employee.

"It was written into the law to avoid paying for disability longer and to get people back into the workforce faster," explained Amélie Quesnel-Vallée, a McGill professor who specializes in health policy.

They are recommending that their patients engage in illegal activities, essentially.- McGill Prof. Amélie Quesnel-Vallée, health policy specialist

However, Quesnel-Vallée said, in using the loophole without verifying if the patients are employed by the billed company, she believes doctors are "violating the principle of the law."

"It's there for when you need it, but they shouldn't be encouraging patients to go and get this loophole," said Quesnel-Vallée.

"They are recommending that their patients engage in illegal activities, essentially." 

The FMSQ said it doesn't have enough information about these two cases to determine whether the doctors are respecting the law or not. However, the federation specified it does not condone any strategy that blocks services for people covered by medicare. 

Quebec's medical insurance board, RAMQ, told CBC that it couldn't comment specifically on anything relating to Rockland MD, because the government agency is currently suing the clinic over alleged illegal billing.

But RAMQ's spokesperson said, in general, doctors aren't allowed to tell patients to find any registered company and ask them to be billed for services provided.

The patient needs to be employed by the company that pays for private medical services, the spokesperson said.

The health insurance board invites any Quebecer who has been asked to pay for health services through a third party who is not that person's employer to contact RAMQ, so it can investigate.