BILL 92 – 2003
MEDICARE PROTECTION AMENDMENT ACT, 2003

HER MAJESTY, by and with the advice and consent of the Legislative Assembly of the Province of British Columbia, enacts as follows:

1 Section 5 (1) of the Medicare Protection Act, R.S.B.C. 1996, c. 286, is amended by adding the following paragraph:

(j.1) make payments and recover debts referred to in section 21 (2); .

2 Section 15 (1) is amended by repealing paragraph (d) and substituting the following:

(d) a determination by the commission that the practitioner has

(i) attempted to contravene section 17, 18, 18.1 or 19,

(ii) contravened section 17, 18, 18.1 or 19, or

(iii) authorized, assisted or allowed another person to contravene or attempt to contravene section 17, 18, 18.1 or 19, .

3 Part 4 is amended by adding the following section:

Definition

16.1 In this Part:

"another person" or "the other person" means, if charged for or in relation to a service or benefit,

(a) the recipient of the service,

(b) the beneficiary, or

(c) a person who is not described by paragraph (a) or (b);

"charge another person" includes solicit, demand, require, receive, obtain, acquire, or accept from the person being charged, in any form or manner,

(a) a payment of money, goods or a service of any kind, or

(b) valuable consideration, enrichment, profit, gain, promise or advantage.

4 Section 17 (1) is repealed and the following substituted:

(1) Except as specified in this Act or the regulations or by the commission under this Act, a person must not charge another person

(a) for or in relation to a benefit, or

(b) for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of a benefit.

(1.1) The commission may determine that a person charges in relation to a benefit for the purposes of subsection (1) (a) if the charge is for anything done, provided, offered, made available, used, consumed or rendered

(a) at any time in relation to the rendering or refusal to render the benefit, and

(b) in circumstances that a reasonable person would consider would result in

(i) a refusal to render the benefit if the thing were not done, provided, offered, made available, used, consumed or rendered, or

(ii) the beneficiary being rendered the benefit in priority over other persons or being given preferential treatment in the scheduling or rendering of the benefit if the thing were done, provided, offered, made available, used, consumed or rendered.

(1.2) If a person charges or attempts to charge another person contrary to subsection (1), another person is not liable to pay the amount charged.

5 Section 18 is repealed and the following substituted:

Limits on direct or extra billing by a medical practitioner

18 (1) If a medical practitioner who is not enrolled renders a service to a beneficiary and the service would be a benefit under this Act or the Hospital Insurance Act if rendered by an enrolled medical practitioner, a person must not charge another person for, or in relation to, the service, or for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of the service, an amount that, in total, is greater than

(a) the amount that would be payable under this Act, by the commission, for the service if rendered by an enrolled medical practitioner,

(b) if a payment schedule or regulation permits or requires an additional charge by an enrolled medical practitioner, the total of the amount referred to in paragraph (a) and the additional charge, or

(c) the amount that would be payable under the Hospital Insurance Act, for the service if rendered by an enrolled medical practitioner.

(2) Subsection (1) applies only to a service rendered in

(a) a hospital as defined in section 1 of the Hospital Act,

(b) a facility as defined in section 1 of the Continuing Care Act,

(c) a community care facility as defined in section 1 of the Community Care Facility Act that receives funding for the service through a regional health board, the Nisga'a Nation or the Provincial Health Services Authority, or

(d) a medical facility or diagnostic facility if

(i) a regional health board as designated under section 4 of the Health Authorities Act, or

(ii) the Provincial Health Services Authority

has contracted to have the service rendered.

(3) If a medical practitioner described in section 17 (2) (c) renders a benefit to a beneficiary, a person must not charge another person for, or in relation to, the benefit, or for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of the benefit, an amount that, in total, is greater than

(a) the amount that would be payable under this Act, by the commission, for the benefit, or

(b) if a payment schedule or regulation permits or requires an additional charge, the total of the amount referred to in paragraph (a) and the additional charge.

(4) If a medical practitioner who is not enrolled charges another person contrary to subsection (1) or (3), another person is not liable to pay the amount charged.

Limits on direct or extra billing in a diagnostic facility

18.1 (1) Unless a service is rendered by a medical practitioner who is not enrolled, a person must not charge another person for, or in relation to, the service if that service

(a) would be a benefit under this Act, or a benefit under the Hospital Insurance Act, if rendered to a beneficiary at

(i) an approved diagnostic facility,

(ii) a hospital, or

(iii) a diagnostic facility under an agreement with a regional health board, the Nisga'a Nation or the Provincial Health Services Authority, and

(b) is rendered to a beneficiary at a diagnostic facility that is not approved under section 33.

(2) A person must not charge another person for, or in relation to, materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of a service described by subsection (1).

(3) If a person charges another person contrary to subsection (1) or (2), the other person is not liable to pay the charge.

6 Sections 19 and 20 are repealed and the following substituted:

Notice requirement

19 (1) Before a beneficiary is rendered a service described in subsection (1.1), the person who intends to charge another person for, or in relation to, the service must advise the beneficiary, in a manner the beneficiary can understand, of the following:

(a) that the person intends to collect the amount from the other person;

(b) how much the person who intends to charge will charge for, or in relation to, the service;

(c) how much, if anything, the person who intends to charge reasonably expects that the commission will reimburse the other person for the rendering of the service.

(1.1) A service for the purposes of subsection (1) means a service that

(a) would be a benefit if rendered by a practitioner, or

(b) would be a benefit under this Act, or a benefit under the Hospital Insurance Act, if rendered by a practitioner to a beneficiary at

(i) an approved diagnostic facility,

(ii) a hospital, or

(iii) a diagnostic facility under an agreement with a regional health board, the Nisga'a Nation or the Provincial Health Services Authority.

(2) If a person intends to charge a person who is not the beneficiary for a service in the circumstances described in subsection (1), the person who is not the beneficiary must be advised as described in that subsection in a manner that person can understand.

(3) Subsections (1) and (2) do not apply if the medical condition or incapacity of the persons to be advised makes compliance with those subsections impracticable.

(4) If a person is not advised as required by this section, the person is not liable to pay for the service unless the service was rendered in an emergency situation that made it impracticable to comply with the requirement to advise.

Refunds

20 (1) If a person pays for a service described in section 18, the person who charged for, or in relation to, the service, or for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of the service, must refund to the person who was charged any amount paid that is in excess of the amount allowed by section 18.

(2) If a person pays for, or in relation to, a service, or for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of the service, but there was no liability to pay all or a portion of the amount paid because of section 17 (1.2), 18.1 (3) or 19 (4), the person who charged for, or in relation to, the service, or for materials, consultations, procedures, use of an office, clinic or other place or for any other matters that relate to the rendering of the service, must refund the excess payment to the person who paid.

(3) If, in respect of a particular service, there are 2 or more persons to whom subsection (1) or (2) applies, the amount that is to be refunded must be divided among all persons who paid, in proportion to each person's share of the total amount paid.

7 Section 20.1 is repealed.

8 Section 21 is renumbered as section 21 (1) and the following subsections added:

(2) The commission and a person who pays the amount referred to in subsection (1) may agree that

(a) the commission will pay the person all or part of that amount, and

(b) in consideration for the payment under paragraph (a), the commission is assigned the right of the person to recover all of the debt referred to in subsection (1).

(3) The commission may recover a debt assigned to it under subsection (2) by

(a) action in any court of competent jurisdiction, or

(b) setting off the debt against monies owed, or that may become due and owing, by the commission to the person who owes the debt referred to in subsection (1).

9 Section 34 is repealed.

10 Section 36 is amended:

(a) in subsection (1) by repealing the definition of "practitioner" and substituting the following:

"practitioner" includes

(a) a former practitioner, and

(b) a medical practitioner who is not enrolled and to whom section 18 (1) applies; ,

(b) by repealing subsection (2) and substituting the following:

(2) The commission may appoint inspectors to audit

(a) claims for payment by practitioners and the patterns of practice or billing followed by practitioners under this Act,

(b) the billing or business practices of persons who own, manage, control or carry on a business for profit or gain and, in the course of the business, direct, authorize, cause, allow, assent to, assist in, acquiesce in or participate in the rendering of a benefit to beneficiaries by practitioners, and

(c) the billing or business practices of persons who own, manage, control or carry on a business for profit or gain and who the commission on reasonable grounds believes

(i) in the course of the business, direct, authorize, cause, allow, assent to, assist in, acquiesce in or participate in the rendering of a benefit to beneficiaries by practitioners, or

(ii) have contravened section 17, 18, 18.1 or 19. ,

(c) in subsection (4) by striking out "subsection (2)" and substituting "subsection (2) (a)",

(d) by adding the following subsection:

(4.1) An audit under subsection (2) (b) or (c) may be made in respect of billing or business practices followed by persons before the coming into force of this subsection. , and

(e) by repealing subsection (5) (a) and substituting the following:

(a) records of a person described in subsection (2) (b) or (c) or of a practitioner, and .

11 The following section is added:

Injunctions

45.1 (1) The commission may apply to the Supreme Court for an injunction restraining a person from contravening section 17 (1), 18 (1) or (3), 18.1 (1) or (2) or 19 (1) or (2).

(2) The court may grant an injunction sought under subsection (1) if the court is satisfied that there is reason to believe that there has been or will be a contravention of this Act or the regulations.

(3) The court may grant an interim injunction until the outcome of an action commenced under subsection (1).

12 Section 46 is amended by adding the following subsections:

(5.1) A person who contravenes section 17 (1), 18 (1) or (3), 18.1 (1) or (2) or 19 (1) commits an offence.

(5.2) A person who is convicted of an offence under subsection (5.1) is liable to a fine of not more than $10 000, and for a second or subsequent offence to a fine of not more than $20 000.

13 Section 1 of the Supplement to the Medicare Protection Act is repealed.

Consequential Amendments

Community Care and Assisted Living Act

14 Section 54 of the Community Care and Assisted Living Act, S.B.C. 2002, c. 75, is repealed.

Medicare Protection Act

15 Section 18 of the Medicare Protection Act, R.S.B.C. 1996, c. 286, as enacted by the Medicare Protection Amendment Act, 2003, is amended by repealing subsection (2) (c) and substituting the following:

(c) a community care facility or assisted living residence as defined in section 1 of the Community Care and Assisted Living Act that receives funding for the service through a regional health board, the Nisga'a Nation or the Provincial Health Services Authority, or .

Commencement

16 This Act comes into force by regulation of the Lieutenant Governor in Council.