In addition to increasing access to surgeries and MRIs, the Government of British Columbia is bringing into force outstanding sections of the Medicare Protection Amendment Act, 2003, to further support patients and strengthen B.C.’s public health-care system, Adrian Dix, Minister of Health, announced today.
“I am taking action today to protect our public health-care system, and to correct the previous government’s failure to enforce the law, something done at the expense of patients,” said Dix.
The Medicare Protection Amendment Act, 2003, which enhances authority around extra billing, was passed in 2003, but some sections were not brought into force. Currently, the Medical Services Commission can audit practitioners and clinics, and can seek a court-ordered injunction to stop the practice of extra billing, but other actions are limited.
Extra billing means charging a patient or a representative for health care that should be provided at no cost, because it is covered under the Medical Services Plan (MSP), or publicly funded as a benefit under the Hospital Insurance Act.
During 2017-18, the Ministry of Health audited three private clinics. Based on these audits, as well as a previous one, Health Canada estimated that extra billing in B.C., in violation of the Canada Health Act, for the 2015-16 fiscal year, was $15.9 million. In March 2018, federal health funding to B.C. was reduced by this amount.
“The consequences of the failure of the previous government to enforce the law has cost patients millions of dollars. This has to stop,” said Dix. “We are taking strong action today and will be asking the federal government to restore funding to B.C. in the coming year as a result.”
Sections of the Medicare Protection Amendment Act, 2003 that are coming into force, and new actions that can be taken by the Medical Services Commission, include:
- Making it an offence to extra bill for services insured under the Medicare Protection Act or the Hospital Insurance Act;
- Clarifying that selling priority access to medically necessary care is extra billing;
- Providing new protections for beneficiaries and establishing that they are not liable to pay for extra billing charges;
- Creating consequences for practitioners, or others, such as privately owned medical clinics, who have extra-billed beneficiaries;
- Ensuring that all diagnostic facilities, including non-approved diagnostic facilities, cannot charge beneficiaries for diagnostic services if the services would be covered under MSP.
With implementation of these new provisions, government has clarified the rules around extra billing, authorized the Medical Services Commission to refund beneficiaries in cases of extra billing and set out clear consequences for breaking those rules. Any person who extra bills may now be required to refund the fee paid, face fines of up to $10,000 for a first offence, and $20,000 for a second offence if convicted of wrongly charging patients. Practitioners may also be de-enrolled from MSP, making them unable to bill the public health-care system. Six clinics have audits planned for this fiscal year: three are already underway; three are in the planning stage.
The changes do not stop the current practice of health authorities partnering with private providers or private clinics, as long as the services are publicly funded, and patients are not required to pay out of pocket. As well, these changes do not prevent patients from choosing to pay for services, such as cosmetic procedures, that are not medically necessary MSP benefits.
MSP pays for medically required services provided to British Columbians, and the Medicare Protection Act sets rules for billing for services provided by physicians and certain other health-care practitioners who are enrolled in the plan. Generally, charges for benefits must be submitted directly to MSP by practitioners, rather than to patients or their representatives.
Under the BC Surgical and Diagnostic Imaging Strategy, approximately 9,400 more publicly funded surgeries will be completed by the end of March 2019. The strategy will improve timely access to surgery through a more efficient surgical system, and will help the Province catch up with and keep up with demand, starting with hip and knee replacement surgery and dental surgery. It will also improve the patient’s experience, by focusing on improving surgical pathways, co-ordination of care and information provided to patients. Additionally, $11 million in funding is being made available to grow MRI capacity in the public-health system and achieve a total of 225,000 MRI exams in 2018-19.
A backgrounder follows.
Ministry of HealthCommunications
250 952-1887 (media line)
In 2003, Bill 92 was passed by the legislative assembly as a series of amendments intended to fortify the Medicare Protection Act (MPA) by clarifying and strengthening the prohibitions against extra billing. It was intended to ensure the Province was in compliance with the principles of the Canada Health Act.
At the time, only the portion of Bill 92 that provided the Medical Services Commission additional powers of audit and inspection, and the right to apply for court injunctions, were brought into force. The remaining provisions of the act were not proclaimed.
Outstanding sections of the act that are coming into force include the following:
- Making it an offence to extra bill and create offences for extra billing along with significant fines (s. 46(5.1)(5.2));
- Clarifying that selling priority access to medically necessary care is extra billing (s. 17(1.1));
- Providing new protections for beneficiaries and establishing that they are not liable to pay for extra billing charges (s. 17(1.2), 18(4), 18.1(3), 19(4), 20, 21);
- Creating consequences for practitioners, or others, such as privately owned medical clinics, who have extra-billed beneficiaries (such as requiring them to refund the amounts paid) (s. 20); and
- Ensuring that all diagnostic facilities, including non-approved diagnostic facilities, cannot charge beneficiaries for diagnostic services if the services would be covered under MSP (s. 18.1).
Extra billing involves charging a MSP beneficiary for a service that is covered under MSP, or is covered under the Hospital Insurance Act, unless otherwise permitted under the Medicare Protection Act or by the Medical Services Commission. Under Section 18, a practitioner who is not enrolled in MSP is not permitted to charge more than they could if they were enrolled, if the service is provided in a hospital, a continuing-care facility, publicly funded community-care facilities, assisted living residences or a health authority.