Copeman clinic trying to purge patients who don't pay

The CBC has uncovered evidence thatCopemanHealthcare Centrein Calgary is trying topurge patients who can nolongerpay the clinic's fee.

Fee-paying patients at the clinic who lose their jobs, or their work benefits, are regularly told their options for continued care are to keep paying fees or get a referral elsewhere.

Thisdespite Alberta lawthatsays access to insured services like doctor visits can't be tied to fees.

Until last year, more than 100employees of Athabasca Oil,a large client of Copeman,had a benefits package that covered the clinic's annual membership fees. Those amountto more than $3,000 annually for an individual. Thecost is higher in the first year, though corporate clients typically enjoy a discount.

Last Autumn,Athabascacut staffand the benefits for remaining employees, meaningthe private clinic's fees were no longer covered formost workers.

In response, Rick Tiedemann,head of business development for the chain of four privateclinics,warnedCalgary staffnot to discuss the patients' option to continue to see their doctorwithout paying.

"Please DO NOT discuss MSP options or other variances of our programs/fees," readsTiedemann'semail.

"MSP" is lingo thatrefers to British Columbia'sMedical Services Plan, essentiallyitsprovincial health-care coverage, sources at the clinic say. Copeman's head office clinic is in Vancouver.

"Simply refer them to Carlene for a conversation that will allow them to explore their care/fee options," the memoreads.

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Doctors at Copeman bill Alberta Health for patient visits

Though Copeman isaprivate clinic, doctors bill Alberta Health for patient visits. The companywebsitesays the fees it levies are "strictly for non-insured health services," like visits to a dietitian.

TheAthabascaclients typically enjoyed full "life plus" memberships at the clinic, which included family physician care for themselves and their families.

In an ongoing investigation, the CBC hasinterviewed more than half a dozen current and formerCopemanstaff.

The sources say the Carlenenamed in the memorefers to CarleneClemence, the Calgary clinic's manager of business development.

They also say that both business development staff and those in administration, who dealt directly with patients, were instructedneverto volunteer the option of continuing to see their family doctorfor patients no longer paying clinic fees.

If patients seemed especially well informed of their rights, one source said, the cliniccould tell them it would consult their physician and go from there.

Cannot bill for medically necessary care

"What the Canada Health Act does say is that you can't have extra billing or user charges for medically necessary care, which is what the clinic isdoing," saidColleen Flood,a professor and expert in health law and policy atthe University of Ottawa.

Flood noted that,in her opinion, the membership feesCopeman charges already cross that line. But she said that this is federal legislation, and enforcement has largely been left to the provinces.

Andrew MacKendrick, press secretary to federal Minister of HealthJane Philpott, said the issue is "under provincial health jurisdiction."

"If a fee is a condition for receiving insured services from an opted-in physician, then what Copemanis said to be doing violates theAlberta Health Care Insurance Act," said Erin Nelson, a professor and expert in health law at the University of Alberta.

"But the act doesn't specify what information must be provided topatients.I don' t think the act is that specific. ButI think from an ethical and professional standpoint it's a concern."

The CBC attempted to contactClemence andTiedemann, butneither responded to requests for an interview.

Copeman CEOChris Nedelmann declined to comment.

Alberta governmentinvestigatingCalgary clinic

The Alberta governmentis auditing both the Calgary and Edmonton clinics. The Special Investigations Unit, part of Service Alberta,is also conducting a probe of the business.

The CBC investigation found that, until last year, Copemanhadbeen billing Alberta Health for medical tests many of its own doctors believed were unnecessary.

The bills to patients are also structuredso that the cost of a Copemanmembership can be expensed through health-spending accounts offered by some employers. The cost of these accounts to employers is a tax deduction, so the expense of Copeman's fees is also defrayed by thefederal government.

Copeman's Calgary clinic has been at the centre of the CBC's investigation, but sources say most policies including mandates to subject all patients to the same range of medical tests came from thehead office in Vancouver.

A spokeswoman for B.C.Health Minister Terry Lake said in an email that the government performs audits of clinics like Copeman where necessary. She did not respondwhen asked directly if the B.C. government is auditing or considering auditing Copeman'stwoVancouver clinics.

But pressure to do so is building.

NDP MLA Judy Darcy, the official opposition's spokesperson for health, issued a letter to Minister Lakeurging him to follow the lead of officials in Alberta.

"The Alberta clinics are directed from the head office in Vancouver," her letter reads."We think this should be the impetus to lead your ministry to launch a thorough investigation into the practicesof the B.C. clincis."