QUÉBEC, May 25, 2016 /CNW Telbec/ - Today, Ms. Guylaine Leclerc makes public the report entitled Value-for-Money Audit (spring 2016). Chapter 3 reproduces entirely the report made public on May 10, 2016 concerning the billed clinical costs for medical services. The audit was carried out at the Ministère de la Santé et des Services sociaux (MSSS) and at the Régie de l'assurance maladie du Québec (RAMQ).
The billing of clinical fees: a situation that has been ambiguous, confusing and misunderstood for many years. Even though various actors have intervened, the legal framework does not make it possible to adequately control this billing. The amendment to the Health Insurance Act (Bill 20) and Bill 92 aim at improving the situation.
Neither the MSSS nor the RAMQ have a complete picture of the clinical fees billed to patients. The government recently estimated those fees at $50 million, but this assessment is not based on any analysis.
The MSSS does not properly fulfill its supervisory role with regard to the billing of clinical fees for medical services: lack of tools for assessing the operating costs of clinics in order to support funding needs; little knowledge about the funding that clinics and physicians receive from the government to pay for operating costs.
The measures available to the Régie to control the billing of clinical fees are limited by the current legislative and regulatory framework: several elements that limit recourses for patients; requirements that reduce reimbursement possibilities for patients; complex process for the recovery of sums owed by clinics; investigations ending with information sent to physicians and clinics, with no penalties for them.
There is a good practice at the RAMQ. It carries out prevention work regarding the billing of clinical fees for medical services among physicians as part of clinical visits. However, few efforts are made to inform the population of the applicable regulation.
The Highlights are available at www.vgq.qc.ca. The full report is available only in French.
Lucie Roy, Director
SOURCE Vérificateur Général du Québec
For further information: Lucie Roy, Director, Cabinet, communications et affaires stratégiques, Auditor General of Québec, Tel.: 418 691-5915