Both province and patients pay for tests at Copeman Clinic

TheCopemanclinic, a private medical facility,has been billing Alberta Health for medical tests many of its own doctors believed were unnecessary.

Allegations of over-testinghave been raised before; but until now it was not clear that several layers of government were defrayingthe cost.

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Copemanbills are also structuredso that patients, and their employers,throughhealth spending accounts,may apply the expenseas a tax deduction.

Calls toCopemanCalgary's CEO, ChrisNedelman, were not returned.

Mosttests covered by Alberta Health

WhileCopeman'sin-house lab took patients' blood and urine samples, it has almost no capacity for analysis, and the vast majority of analysis work was done, and paid for,by the province, sources told CBC News.

"We stick a needle in you, take your blood, and then we send it to the province," one sourcesaid."It worked that way for blood, for urine, for the stooltest. We sent it all to Calgary Lab Services,daily, which was then covered by Alberta health caretaxpayers."

A CBC News investigation,involving interviews with over half a dozen current and formerstaff,found that doctor approvalforsuch tests was routinely circumvented by the clinic's administrative processes. Head office, in Vancouver, sources say, set out a "standard lab and diagnostic schedule."

These included blood, urine and stool analysis,and other diagnostic tests, likeECGs,spirometryandtonometery.

The sources saythe practice started as early as 2011, and lasted until the second half of 2015, by which timesix, or roughly half,the clinic's family doctors had left the facility over the course of the previous12 months.

Of the 19 tests and assessmentsCopemanset out in its 2012 schedule for standard patient testing,16 are covered by Alberta Health.On an initial visitfor men over aged 50, for example, the cost absorbed by the province for lab analysis alone reached $347 per patient.

Calgary Lab Services, which analyzesblood, urine and stool testsfor community physicians, including those atCopeman, declined to confirm a dollar figure, paid by the province,for testing and analysis conducted on the part of theclinic.

Spokeswoman ElaineRudysaid in an email that generating the information would be too time-consuming. But she confirmed that CLS would not charge the requestor for any testscovered by Alberta Health.

At press time Alberta Health was unable to supply the total cost of otherCopemantests, includingECGs, ECG stress tests,tonometryandspirometry,for the period 2012 to 2015.

Government audit on Copeman

However, the government says it is conducting an audit of both the Calgary and EdmontonCopemanclinics, a process it says includesa financial aspect.

Copeman's website notes "...fees charged by Copeman Healthcare are strictly for non-insured health servicesCopeman Healthcare or physicians working at the Centre, may also bill the provincial health insurance plan for a comprehensive physician visit, general visits, as well as certain tests such as ECGs, stress ECGs, audiometry, tonometry and spirometry."

But some patient bills appear to tell a different story.

Patients are also billed

Patients are also billed for the tests, allowing them to claim the costs against health spending accounts, or, in some cases, as tax deductions in their personal tax filings.

More than a dozen patient receipts obtained by CBC Newsshow lump sum charges of over $1,000 for the lab and diagnostic work, all of which is cited as "physician prescribed." That language means the cost of eligible analysis work would be borne by the province.

Erin Nelson, a professor and expert in health law at the University of Alberta, said Copeman'sapparentpractice of billing both patients and the governmentmay not breakhealth laws in the province. "It may not violate the letter of the Health Care insurance Act, but it should be of concern to the public.It's a grey area and lacking clarity. It hasn't been tested that I'm aware of."

CBC News also obtained a patient bill that shows a $1,283 charge for a "physician consultation, assessment, interpretation and report. Physician follow-up consultation(s). Continual care."

In that case, Dr. Nelson said that charge appears to go against the spirit of the Alberta Health Care Insurance Act, which prohibits socalled double billing, preventing physicians from charging patients for insured health services also billed to the province.

Patients can passcost to employers, and claim a tax credit

The Canada RevenueAgency's (CRA)guidelines disallow the cost of "membership fees or access fees" paid to private medical clinics. However, "an amount paid to a medical clinic that can reasonably be considered a prepayment of medical services that are to be provided over the course of the year will generally be eligible."

Copeman bills viewed by CBC News show receipts dated at year end or early in the new year, for services to be delivered at a later datethe total adding upto Copeman's annualmembership fee.

Some patients can recoup Copeman fees through health spending accounts, which are administered by health insurance companies, butpaid for by employers. Alternatively, some can apply many of the expenses itemized by the clinic as a tax deduction.

The CRA's list of allowable medical expenses includes ECGs, laboratory procedures or services including necessary interpretations, as well as testing likespirometry and tonometrywhen provided by a qualified practitioner.

Canada RevenueAgency spokesman David Walters confirmed that tax filers are not required toknowwhether an expensehas already beenpaid for by the province.

Health spending accounts generally followthe federal government's list of allowable expenses. While employerspay the cost, they are allowed to write off the expense against earnings, said Grant Popowich, a partner with Grant Thornton LLPin Edmonton.

Issues around over-testing were also raised in a lawsuit filed earlier this year. Copeman launched a suit against two of its former doctors,one of whom is the clinic's former medical director.

The clinic alleges the doctors are now unfairly competing with Copeman at their newly opened facility. The doctors deny the allegations. In a counter suit, the doctors allege the clinic subjected patients to unnecessary testing in doctors' names, without their knowledge.

The clinic denies theallegations. Its filings claim, "at no time did Copeman direct that any physician order medically unnecessary tests."

None of the allegations have been tested in court.

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