Over $42K in wrongful fees charged to Ontario patients by clinics since 2018

As one of the biggest changes to how health care is delivered in Ontario for a generation passes its third reading — and advocates raise concerns about widespread privatization — new data shows complaints about improper charges for health care have been relatively rare in recent years.

Since the Ford government took power in 2018, around $70,000 in medical fees have been found to violate legislation that outlaws charges for procedures or services that are covered by public insurance.

The vast majority of improper charges were found to be by clinics.

The right to universal access to health care procedures covered by provincial insurance OHIP is enshrined in law, and anyone found to be charging patients for a service that should be free can be fined.

The number of successful complaints every year, however, has numbered fewer than 100 over the past decade. In 2020-2021, for example, only 15 complaints were considered to have broken rules.

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What that says about the system depends on who you ask: government officials suggest it shows strong oversight will protect patients as the private sector helps to clear surgical backlogs, while advocates believe it is evidence people aren’t able to complain and issues with for- profit health care go unreported.

Between 2012 and 2022, an average of 101 complaints were submitted every year from patients alleging they had been forced to pay for a health service that should have been free. On average, 43 complaints were upheld each year, according to data shared with Global News by the province.

Through the same period, the total annual value of charges found to violate the rules ranged significantly. In the highest year, the violation charges sat at $341,980.40 (2012-2013), falling as low as $3,527.15 in the 2020-2021 year.

On Monday, the Ford government passed the third reading of a health-reform bill (Bill 60) that will allow more private clinics to offer certain publicly-funded surgeries and procedures in an effort to cut long wait lists for care.

Cataract surgeries and diagnostic imaging and testing will be expanded while the government will create an entirely new system to perform hip- and knee-replacement surgeries.

The province argues its new legislation will further strengthen protections, reiterating the right of people in Ontario to receive health care that is free at the point of use.

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“Bill 60, if passed will also establish a robust framework for the oversight of community and surgical diagnostic centers, including a provision to bring these centers under the oversight of a patient ombudsman, and puts into law that Ontarians will always access insured services at community surgical and diagnostic centers with their OHIP card and never their credit card, consistent with the Canada Health Act,” a spokesperson for Health Minister Sylvia Jones told Global News.

There are already about 900 private clinics currently operating across the province, the vast majority of them for diagnostic imaging and testing.

Others have said that a system that depends on proactive complaints simply cannot protect patients.

“Every time I speak with a patient who’s been extra billed, they’re quite surprised that it’s not allowed,” Natalie Mehra of the Ontario Health Coalition told Global News.

“We get more (complaints) than ourselves,” she said of the data showing the average of 101 complaints per year in Ontario.

“But a lot of people don’t want to go public, they don’t want to go forward publicly. I just think people don’t know where to complain… it’s not easy to find on the government website, even I have to go combing through to find out where it is. It’s not like they go out of their way to make it too easy.”

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The data shared with Global News shows that, since the Ford government took office in 2018, patients were charged more than $42,000 incorrectly for services that should have been free at clinics.

Specifically, $42,157.31 in charges at clinics were deemed violations of legislation since the 2018-2019 year. A total of $225 charges from independent health facilities were found to be wrong.

The data’s definition of a clinic could include spaces that were previously held with an independent health facilities license but were no longer licensed under that structure when the numbers were collected.

Both clinics and independent health facilities are health-care settings outside of hospitals which may be operated for-profit and provide services including diagnostics or imaging. Clinics are non-hospital spaces that offer services that range from X-rays to ultrasound scans and do not hold an independent health facility license, which are adjacent but separately regulated.

Other places were also guilty of charging patients for procedures or services that should have been free and covered by OHIP.

In 2021-2022, hospitals wrongly charged patients $6,896.20 for services such as diagnostics that should have been covered for OHIP. Physicians did the same to the tune of $1,560.50, according to the data. Optometrists were found guilty of $55 in incorrect fees and laboratories $1,100.

The fines for those found guilty of wrongful charging are laid out in the Commitment to the Future of Medicare Act. Different fines include a maximum of $1,000 in one instance and a maximum of $25,000 for another.

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New Democrat Leader Marit Stiles said the government’s new Bill 60 will create longer wait times, leave emergency departments shuttered and increase exhaustion for already-stressed health-care workers.

“That is not the health-care system that I think Ontarians need or deserve or want,” she said.

She also warned of clinics possibly “upselling” patients by pressuring them to choose a service or product that costs more than what the Ontario Health Insurance Plan covers.

Upselling differs from the violations under the Commitment to the Future of Medicare Act, which specifically forbids charges to access services covered by OHIP which should be free.

Someone would be upselling if they offered a patient a premium service not covered by OHIP. That would not be forbidden unless they somehow misled the person into thinking it was medically necessary instead of being an optional upgrade.

Adil Shamji, the Liberal health critic, said there is a role for diagnostic services and surgeries to be done outside of hospitals.

“But it needs to be done in the right way,” he said. “It needs to be not-for-profit, hospital-affiliated with credible protections to prevent siphoning of health-care workers and staff.”

The province said its new legislation will better protect patients, even as their interactions with for-profit facilities increase.

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“Our government’s Your Health Act (Bill 60), will strengthen oversight of community surgical arrangements while protecting the stability of doctors, nurses and other health-care workers in our health care system,” the provincial spokesperson said.

The Ontario Health Coalition, however, argues that strengthening the system is not enough.

“It’s going to be almost impossible to stop them,” Mehra said of for-profit charges. “The way to stop them is to stop the services from being turned over from our public hospitals to these private entities that then go and do all this extra billing and charging of patients and are almost impossible to catch up with.”

Many details of the new system will not be revealed until the government proposes regulatory changes.

— with files from The Canadian Press

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