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Monday, October 22, 2018
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B.C. government cracking down on over-billing by healthcare providers

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VANCOUVER, B.C. — Health Minister Adrian Dix announced today that the provincial government will be bringing outstanding sections of the Medicare Protection Amendment Act of 2003 into force order to crack down on extra billing by healthcare providers.

In a release today, the government said that the Medicare Protection Amendment Act was created in 2003 under the BC Liberals to enhance authority around extra billing, but that some sections were not brought into force. Before today’s announced changes, the Medical Services Commission was able to audit practitioners and clinics and seek a court injunction to stop practices of extra billing, but other actions are limited.

Extra billing involves charging a MSP beneficiary for a service that is covered under MSP or 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, continuing-care facility, publicly funded community-care facility, assisted living residence, or a health authority.

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; and ensuring that all diagnostic facilities, including non-approved diagnostic facilities, cannot charge beneficiaries for services that would be covered under MSP.

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“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 consequences of the failure of the previous government to enforce the law has cost patients millions of dollars. This has to stop. 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.”

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. Practitioners may also be de-enrolled from MSP, making them unable to bill the public health-care system.

The changes will 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. The changes also don’t prevent patients from choosing to pay for services 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.

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