The federal government intends to recover $76 million from seven provinces which it accuses of billing for diagnostic health imaging services. And it is Quebec that will bear the biggest bill, nearly $42 million. The federal Minister of Health, Jean-Yves Duclos, also warns his counterparts that he could repeat the offense if the provinces do not tighten the use of private and telemedicine as well as virtual care on their territory.
“Residents have been found to have had to bear the cost of obtaining diagnostic services, such as ultrasounds, MRIs and CT scans – services that should be available free of charge,” lamented Minister Duclos Friday morning. “This situation is unacceptable and will not be tolerated,” he said.
The federal Minister of Health, Jean-Yves Duclos, has thus indicated that he will deduct from the federal health transfers paid annually to the provinces – and which will be sent to them in the coming days – the sums equivalent to this billed care.
Quebec will therefore see its share of the federal transfer reduced by $41.87 million. This is by far the largest sum. British Columbia loses $17 million from its transfer, Alberta close to $14 million and the other provinces concerned suffer a deduction of just over a million dollars or a few hundred thousand dollars.
Ottawa is also cutting $6 million from British Columbia and a few tens of thousands of dollars from Ontario and New Brunswick due to private surgery and abortion costs billed to patients.
An announced penalty
1er April 2020, Health Canada had clarified its interpretation of the Health Act regarding the imposition of diagnostic fees and had prohibited “any billing to patients for medically necessary diagnostic imaging services […] regardless of where these services are provided”.
The federal ministry had given the provinces until last December to “report” on the fees billed to patients in this way, for the years 2020-2021. It is the assessment of these amounts, for each of the provinces concerned, that is deducted from the Canada federal health transfer.
Health Canada had indicated in its 2020-2021 annual report that Saskatchewan was “the only province that expressly encourages this practice through legislation” but that residents of other provinces, including Quebec, also find themselves having to pay for access to diagnostic services.
Amounts often reimbursed
The federal Department of Health has cut provincial transfers in the past. But these sums, equivalent to each dollar billed to patients, have sometimes been paltry — from $4,500 for Newfoundland to $65,000 in New Brunswick in 2020-2021. Or they ended up being reimbursed, when the provinces took corrective measures.
Quebec had thus recovered the $9.9 million invoiced in ancillary costs in 2014-2015 which had first been deducted from it by Ottawa. An additional $8.2 million was also returned to him, having originally been cut in 2018-19.
Minister Duclos also indicated on Friday that the provinces targeted by these new deductions could once again be entitled to a refund if the fees that the federal government refuses to see imposed are eliminated.
Other predicted sanctions
Minister Duclos also warned his counterparts, by way of missive on Friday, that he intends to adopt the same practice in the file of virtual care and telemedicine billed to patients. “Although these new approaches have many advantages, they have also led to the emergence of new fees imposed on patients,” writes Mr. Duclos in the letter intended for the Quebec Minister of Health, Christian Dubé.
Ottawa is also targeting care delivery through “expanding scopes of practice for health care workers”. Nurse practitioners who have become self-employed, for example, would bill for certain home care services, according to Ottawa.
“In cases where patients are charged a fee for these services, I will be required, in accordance with the Act [sur la santé]to reduce federal health transfers by an equivalent amount,” said Mr. Duclos.
Further details will follow.