Telus Health breaking the law, watchdog alleges

The Medical Services Commission is seeking an injunction to stop clinics owned by Telus from charging membership fees to patients.

Health Minister Adrian Dix said the independent commission is seeking a BC Supreme Court injunction alleging that Telus’s LifePlus program’s billing practices contravene the Medicare Protection Act.

“It is very important to uphold the Medicare Protection Act, which is in place to preserve our publicly managed and fiscally sustainable health-care system,” Dix said. “Access to necessary medical care should be based on need and not an individual’s ability to pay.”

The MSC began the Telus review in February.

The application for an injunction was filed Thursday and includes four affidavits, including one from Mike Campbell, a private investigator, who Telus quoted a price of $4,882 for the first year in the LifePlus Program and $3,882 for subsequent years.

According to the affidavit, a Telus Health clinical enrolment nurse told Campbell he would be unable to see any of the family doctors employed in the program unless he paid the fee to become a member.

Another of the affidavits is from Mark Winston, who last January wrote an article for The Tyee about being asked to pay a fee to keep seeing his doctor after the doctor closed his private practice and began working for Telus Health.

Under the Medicare Protection Act, doctors who receive payments under the public Medical Services Plan may not charge a patient directly for any service normally paid for through public insurance.

“The Commission has investigated and determined that Telus Health is charging for or in relation to MSP covered medical services such that a reasonable person would consider that the purchase of Telus Health’s services would result in preferential treatment or priority access to those services,” the Medical Services Commission said in its court filing.

The commission is seeking a declaration that Telus Health is in breach of Section 17 of the Medicare Protection Act which prohibits extra billing and asks the court “to enjoin Telus Health from continuing this conduct.”

Dix stressed the action only relates to the Telus LifePlus program charging membership fees to patients.

But he added that the message to all health-care providers is that, like anywhere in Canada, “in BC… extra billing contrary to the Medicare Protection Act will not be allowed.”

With representatives from the government, Doctors of BC and the public, the nine-member Medical Services Commission manages the Medical Services Plan and is responsible to ensure some $2.5 billion is spent in accordance with the province’s laws and regulations.

Telus’s vice-president of consumer health, Juggy Sihota, said the company has been co-operating with all requests from the MSC and was surprised it had applied for the injunction.

“We believe that doing so is unnecessary given our fully co-operative approach and commitment of course to always ensuring regulatory compliance for Telus,” Sihota said.

The LifePlus program has about 4,000 customers and 25 doctors, Sihota said. “We do not charge for primary care services with our LifePlus service. Our fee is [for] preventative health uninsured services like dietitians, kinesiologists and wellness services.”

Telus shared lots of information with the MSC and should have been given an opportunity to understand the concern and fix it, Sihota said. “We’re really upset about this because we want to be able to of course address any outstanding issues that they may have regarding compliance,” she said. “We were surprised to receive the injunction and we’re very concerned that we have not been given an opportunity to discuss the matter.”

The court action feels “rather political,” Sihota said. “We would have hoped the government would have been focusing their attention on fixing the significant issues in the public health-care system here rather than firing bullets indiscriminately.”

According to the Medical Services Commission’s petition to the court, between February and October it sent letters to Telus seeking information and received a response to each. “Telus Health and the Commission exchanged correspondence on numerous occasions, and Telus Health provided the Commission with data and information which the Commission has analyzed,” it said.

In responses to the MSC’s questions, Telus claimed that people were not required to pay for LifePlus in order to get access to any insured physician services. The company also said that appointments were “triaged based on urgency” and not whether someone had paid for a LifePlus membership or any other service from Telus Health.

That contradicted what Campbell and Winston had experienced and described in their affidavits, as well as information on the Telus Health website that at times had included statements that LifePlus included “24/7 physician coverage” and that the care team would include “a personal physician.”

Also, analysis by the Health Ministry’s audit and investigations branch found that of the $5.6 million that MSP paid to LifePlus physicians at Telus Health during a period of time, only $342,332 was for people who were not LifePlus members.

=“Patients who pay to be members of the LifePlus program are — or certainly appear to be — gaining preferential access to the family physicians at LifePlus, while those who do not pay Telus Health to join LifePlus are being denied access,” the MSC concluded.

BC Green Leader and Cowichan Valley MLA Sonia Furstenau said her party had long been raising concerns about Telus Health and is relieved action has been taken, but questioned why it took so long.

“While this was being investigated, the BC NDP government should have been creating community health centres across BC to ensure that everyone has access to primary care,” she said in a written statement. “We are concerned that today’s injunction could leave even more British Columbians without access to a doctor.”

Telus and other for-profit companies have stepped in to fill a gap in BC’s health-care system that the government has failed to proactively close, Furstenau said.

Dix said that “the legal process will now unfold as it should” and that the government will continue to strongly defend the public health-care system.

• The Tyee