Doctors' billing is 'ambiguous and confusing,' rules Quebec auditor general

The newest report from Quebec's auditor general claims the provincial government has lost control of doctors' billing of clinical fees.

Guylaine Leclerc describes the current billing procedure for medical services in the public healthcare system as "ambiguous, confusing and misunderstood."

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The Quebec Ministry of Health and Social Services and the provincial public health insurance agency, RAMQ, do not have a "complete picture of the clinical fees billed to patients," according to Leclerc.

RAMQ has a list of 11,000 covered medical procedures. However, in Quebec, doctors are given additional funding when they provide care or treatment outside of hospitals to offset the costs of operating clinics.

Last year, the province provided $150 million in reimbursements to doctors — but it doesn't keep track of what the money was used for, according to Leclerc.

Charging patients more

Quebec physicians are also charging patients above and beyond what they bill to RAMQ to help cover costs for medical procedures.

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The report emphasizes the fees for the same medical procedure vary greatly from one clinic to another. 

No tracking of extra billing

Leclerc found some doctors and specialists charge patients nearly double for certain procedures performed in clinics. The report says one clinic charged $125 for a vasectomy, while another billed patients $225 for the same procedure.

Some patients also shelled out money for additional fees in clinics that aren't authorized, according to Leclerc.

The problem lies in the fact that RAMQ fails to keep track of the total that patients pay annually in clinical fees. The government reported that Quebec patients pay close to $50 million annually, but Leclerc says that isn't based on any actual analysis.

Health Minister Gaétan Barrette says a new law is set to address the problem of extra fees doctors charge to patients.

"The reason why there are accessory fees is simply because the law is unclear," Barrette said.

Recommendations

In her report, Leclerc recommends the Quebec health ministry establish a firm set of clinical fees that doctors can bill to patients.

She also suggests that RAMQ inform patients on what kind of medical procedures and care for which they can be billed.