Acupuncture clinics bend rules to get subsidy

Some B.C. acupuncture clinics are offering Chinese massage and herbal therapy to prospective patients while promising to bill those services to the provincial medical plan as acupuncture.

B.C. regulators promise to investigate

Some B.C. acupuncture clinics are offering Chinese massage and herbal therapy to prospective patients while promising to bill those services to the provincial medical plan as acupuncture, a CBC News investigation has discovered.

"If this is in fact happening, it is fraud," said Dr. Mary Watterson, registrar of the College of Traditional Chinese Medicine Practitioners and Acupuncturists, which regulates acupuncture in B.C.

"It is fraudulent to issue a receipt for something that you haven't done … and it's serious."

The B.C. government decided two years ago to subsidize acupuncture treatments for low-income residents, following lobbying from proponents of traditional Chinese medicine. 

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Watterson said B.C. is the only province that covers acupuncture with public health money.

The provincial medical services plan (MSP) will pay a maximum of $230 per year, per low-income resident, for 10 acupuncture sessions.  Watterson said only acupuncture is covered, not Chinese massage — also known as tui na — or herbs.

"Acupuncture is the insertion of a needle below the dermis. And that is a restricted activity," Watterson said. "Tui na isn't acupuncture. Tui na is a part of traditional Chinese medicine but it's not acupuncture."

Hidden camera investigation

After receiving a tip about potential inappropriate billing, CBC News went into four clinics with a hidden camera to ask what services they would bill to government.

A staff member at the Ha Chinese Medicine Wellness Clinic in Richmond said they would apply the subsidy to Chinese massage and herbs.

The regulator told CBC News that acupuncture must include insertion of needles below the skin to qualify for the subsidy. ((CBC))
"That's not allowed — but we may bend the rule to make it work," the staffer told CBC News in Mandarin. "Generally government does not allow it."

"[The patient] can get tui na … we can deduct [the subsidy]."

Natural Herbs, also in Richmond, told us Chinese massage is covered by the provincial subsidy, though it is not.

"You can have massage or acupuncture … you can also get [the subsidy] … government covers," said a worker at the front counter, who also spoke in Mandarin.

In Vancouver, Alive Sports Chinese Medicine Treatment Centre only offered acupuncture for subsidy. A staff member told CBC News: "We are a legitimate business."

Dr. Harreson Caldwell, who runs the Caldwell Clinic in downtown Vancouver, told CBC News he would just use one tiny needle during hypnosis and bill it as acupuncture.

"I could put an acupuncture seed in your ear. It's like a seed for calming, like a needle, and I can still call it acupuncture," Caldwell told CBC News. "You just write acupuncture on the receipt.

"It's not being dishonest," he said, " because you are using acupuncture and you are using the Chinese meridian system."

Dr. Sunny Lee lobbied for acupuncture to be covered under provincial subsidy. He said questionable billing by some practitioners hurts the entire program and must be stopped. ((CBC))
Dr. Sunny Lee, a Vancouver acupuncturist who lobbied the province for the subsidy, explained the meridian system targets pressure points in the body in traditional Chinese medicine in both tui na and acupuncture.

Tui na and herbs are traditional treatments, often accompanied by acupuncture, he said, but those services should not be billed as acupuncture for the subsidy.

"Some patients say 'I like herbs, I don't like needles,' but the thing is, the point is, we know this MSP program is strictly for acupuncture," Lee said.

"I want our profession not to confuse — and not to cross the line — and keep switching the program," he said. "This thing is not good for this program, and also not good if they continue to do this. It has to be stopped."

Taxpayer bill increasing

B.C. Ministry of Health figures show the cost to B.C. taxpayers for the acupuncture subsidy from March 2009 to March 2010 was $4.3 million — a 61 per cent increase over the previous year.

At $23 per session, that amount covered 188,115 treatments from 741 practitioners. That's an average of 253 treatments per year per practitioner.

Because the subsidy doesn't cover the entire cost of an acupuncture treatment, Lee said, some clinics may be trying to make up the shortfall by billing the government for other services, which is inappropriate.

Registrar Dr. Mary Watterson of the College of Traditional Chinese Medicine Practitioners and Acupuncturists of British Columbia said allegations of inappropriate billing will be investigated. ((CBC))
"I hope the government will have that kind of budget [to cover the entire cost] in the future, honestly, because the $23 is not sufficient for proper treatment," Lee said.

"Maybe there's a possibility that in the future the government know that the acupuncture is actually helping the public and saving in the longer term."

Lee said he hopes people realize that not all Chinese medicine practitioners are taking advantage of the subsidy program.

"This is not the entire traditional Chinese medicine profession," he said. "I hope that the public doesn't get confused that this is the TCM profession doing these things and swapping treatments. It is not."

Investigations to come

Watterson said the college can investigate based on what CBC News discovered. She said violators could face possible penalties up to and including de-registration.

"We can launch an investigation. We can look into it. We can initiate an inquiry case … an investigation, and then it's up to the inquiry committee to look at the evidence and make a decision," she said.

CBC News called each clinic to ask for an explanation.

Angel Wong, manager at Ha Chinese Medicine Wellness Clinic, said pressure to grant the subsidy for other services comes from patients.

"I cannot say that 'no we won't do it,' " Wong said. "If patients ask [for subsidized tui na ] … we cannot refuse them."

Dr. Yu, an acupuncturist at Natural Herb, told us it was a "miscommunication" for staff to tell us we could get services other than acupuncture subsidized.

Caldwell insisted that even if he uses only one small needle in the ear during a hypnosis session, that it is acupuncture and therefore acceptable to bill MSP.

Watterson confirmed as long as one needle is used at any point in the procedure, a practitioner can bill it as acupuncture.

"Acupuncture is the insertion of a needle below the dermis," said Watterson. The key, she said, is whether the dermis is punctured.

Watterson said it's disappointing to hear any allegations about inappropriate billing, considering how hard the profession worked to attain government recognition.

"The health professions are expected to be ethical," she said. "We have high standards in British Columbia, in Canada, and we expect our practitioners to practise in an ethical manner."

CBC News asked for an interview with Health Minister Kevin Falcon, but was told he was not available.

The Health Ministry sent a statement, which reads: "Acupuncture is recognized worldwide as a safe and effective way to treat or manage a variety of health conditions, and we are pleased to offer it as a supplementary benefit for low income British Columbians.

"We take allegations of fraudulent or inappropriate billing very seriously, and if we believe that this is taking place, we will investigate."