Alberta preparing audit plan for medical clinics charging membership fees

Alberta's government is preparing an audit plan to investigate potential health policy breaches by medical clinics charging membership fees for services.

Medically necessary care is guaranteed as part of the Canada Health Act. Provincial health insurance covers hospital visits and doctors appointments, but private medical clinics are allowed to charge for uninsured services.

Pitches from some of those clinics for patients to pay membership fees to access more services or care have raised questions about the boundaries required by that national legislation.

It's those concerns, highlighted by members of the public and health experts, that have prompted the health minister to take a closer look.

"Out of an abundance of caution, the minister has directed her department to further investigate clinics that have a membership component to their services," Minister Adriana LaGrange's office said in a statement to CBC News.

"The department is reviewing a sample of eight clinics in Alberta and will use the results of these reviews to develop their audit plan."

The remaining audits are planned for early in the new year and "appropriate action" will be taken if violations are found.

"We will do whatever it takes to ensure that they're in compliance. We take this very seriously," LaGrange told CBC News on Wednesday, adding she's open to restricting provincial funding to clinics who aren't operating in good faith.

"We take it very seriously. The Canada Health Act and the Alberta Health Insurance Act have to be followed by law."

The health department already monitors billing activities to check if clinics are operating within the legislation. The minister's office also reiterated that Albertans will not pay out of pocket for a hospital or family doctor visit.

Memberships or preferential access?

Uncertainty around that access was at the heart of a recent investigation into a medical clinic in Calgary's Marda Loop neighbourhood.

This summer, CBC News reported that the facility was moving to a subscription system and planning to charge nearly $5,000 a year for a two-parent membership.

Health Canada said that arrangement ran contrary to the act and the province launched an Alberta Health inquiry.

The clinic halted its plan for membership fees shortly after.

Now, another medical office is facing similar queries.

Recently, JW Health in Calgary sent a marketing email saying it was accepting new patients and linked to a webpage with a pricing chart.

JW Health is offering services for about $3,000 a year that include extended hours, no charges for doctors notes, prescription refills without an appointment and preventative screening.

Their website includes a disclaimer that membership fees apply only to uninsured components of care and memberships aren't a prerequisite to access a doctor.

"While access to care is guaranteed, the existing health system may not prioritize convenient patient services. If you seek comprehensive health care beyond brief appointments, our enhanced model emphasizes speed and convenience to cater to your needs effectively," the FAQ reads, under a subheading titled "I thought health care was free in Alberta?"

CBC News inquired about JW's membership model, which prompted the information about the provincial audit.

In a statement, JW Health said the membership model was developed after seeking legal advice and consultations with Alberta's College of Physicians and Surgeons. It added no patients have complained about the change, and should the department order changes to the model, it would comply.

'It's very easy to see how murky this is,' expert says

One public health expert says collecting more information about how these clinics are running is a good step for the province.

"I'm very reassured in the commitment that this government is making to be in line with the Canada Health Act," said Fiona Clement, a professor with the University of Calgary's community health sciences department.

"There's not supposed to be these kinds of differences across the care that Canadians get, but I think it's very easy to see how murky this is.

"It's not technically a medical service, but does it change your outcomes and your experience as a patient? I think probably," Clement said of these clinic memberships.

Health Canada had also pointed to another clinic in Calgary it thought ran afoul of the free access policy.

Under the Canada Health Act, provinces that allow private health-care providers to charge patients for medically necessary services have dollars clawed back by the federal government.

Harrison Healthcare's practices related to diagnostic imaging led to the province getting docked federal health money.

Ottawa deducted $13 million in transfers to Alberta earlier this year.