Both province and patients pay for tests at Copeman Clinic

A CBC News investigation finds tests at a private medical clinic circumvent doctor approval and are billed to both patients and Alberta Health. Patients, and their employers, can then use those bills as a tax writeoff.

Expert says private health-care provider operating in grey area

Chris Nedelmann is CEO of Copeman Healthcare Centre, which has four clinics in three cities: Vancouver, Calgary and Edmonton. Of the 19 tests and assessments Copeman set out in its 2012 schedule for standard patient testing, 16 are covered by Alberta Health, a CBC News investigation reveals. (CBC/Copeman Healthcare Centre Facebook)

​The Copeman clinic, a private medical facility, has been billing Alberta Health for medical tests many of its own doctors believed were unnecessary.

Allegations of over-testing have been raised before; but until now it was not clear that several layers of government were defraying the cost.

Copeman bills are also structured so that patients, and their employers, through health spending accounts, may apply the expense as a tax deduction.

Calls to Copeman Calgary's CEO, Chris Nedelman, were not returned.

Most tests covered by Alberta Health

While Copeman's in-house lab took patients' blood and urine samples, it has almost no capacity for analysis, and the vast majority of analysis work was done, and paid for, by the province, sources told CBC News. 

Patient bills from the Copeman private health-care clinic in Calgary show patients being billed for some procedures that are also charged to Alberta Health. (Tracy Johnson/CBC)

"We stick a needle in you, take your blood, and then we send it to the province," one source said. "It worked that way for blood, for urine, for the stool test. We sent it all to Calgary Lab Services, daily, which was then covered by Alberta health care … taxpayers."

A CBC News investigation, involving interviews with over half a dozen current and former staff, found that doctor approval for such tests was routinely circumvented by the clinic's administrative processes. Head office, in Vancouver, sources say, set out a "standard lab and diagnostic schedule." 

These included blood, urine and stool analysis, and other diagnostic tests, like ECGs, spirometry and tonometery.

The sources say the practice started as early as 2011, and lasted until the second half of 2015, by which time six, or roughly half, the clinic's family doctors had left the facility over the course of the previous 12 months.

Of the 19 tests and assessments Copeman set out in its 2012 schedule for standard patient testing, 16 are covered by Alberta Health. On an initial visit for men over aged 50, for example, the cost absorbed by the province for lab analysis alone reached $347 per patient.

Calgary Lab Services, which analyzes blood, urine and stool tests for community physicians, including those at Copeman, declined to confirm a dollar figure, paid by the province, for testing and analysis conducted on the part of the clinic.

Spokeswoman Elaine Rudy said in an email that generating the information would be too time-consuming. But she confirmed that CLS would not charge the requestor for any tests covered by Alberta Health.

At press time Alberta Health was unable to supply the total cost of other Copeman tests, including ECGs, ECG stress tests, tonometry and spirometry, for the period 2012 to 2015.

Government audit on Copeman

However, the government says it is conducting an audit of both the Calgary and Edmonton Copeman clinics, a process it says includes a financial aspect. 

Copeman's website notes "...fees charged by Copeman Healthcare are strictly for non-insured health services … Copeman Healthcare or physicians working at the Centre, may also bill the provincial health insurance plan for a comprehensive physician visit, general visits, as well as certain tests such as ECGs, stress ECGs, audiometry, tonometry and spirometry."

But some patient bills appear to tell a different story.

Patients are also billed

Patients are also billed for the tests, allowing them to claim the costs against health spending accounts, or, in some cases, as tax deductions in their personal tax filings.

A patient bill shows tests administered at the Copeman private medical clinic in Calgary. (Tracy Johnson/CBC)

More than a dozen patient receipts obtained by CBC News show lump sum charges of over $1,000 for the lab and diagnostic work, all of which is cited as "physician prescribed." That language means the cost of eligible analysis work would be borne by the province.

Erin Nelson, a professor and expert in health law at the University of Alberta, said Copeman's apparent practice of billing both patients and the government may not break health laws in the province. "It may not violate the letter of the Health Care insurance Act, but it should be of concern to the public. It's a grey area and lacking clarity. It hasn't been tested that I'm aware of."

CBC News also obtained a patient bill that shows a $1,283 charge for a "physician consultation, assessment, interpretation and report. Physician follow-up consultation(s). Continual care."

In that case, Dr. Nelson said that charge appears to go against the spirit of the Alberta Health Care Insurance Act, which prohibits so called double billing, preventing physicians from charging patients for insured health services also billed to the province.

This chart shows what the Copeman clinic charged a patient for a series of tests and the amount that Alberta Health typically reimburses for those tests. (CBC)

Patients can pass cost to employers, and claim a tax credit

The Canada Revenue Agency's (CRA) guidelines disallow the cost of "membership fees or access fees" paid to private medical clinics. However, "an amount paid to a medical clinic that can reasonably be considered a prepayment of medical services that are to be provided over the course of the year … will generally be eligible."

Copeman bills viewed by CBC News show receipts dated at year end or early in the new year, for services to be delivered at a later date — the total adding up to Copeman's annual membership fee.

Some patients can recoup Copeman fees through health spending accounts, which are administered by health insurance companies, but paid for by employers. Alternatively, some can apply many of the expenses itemized by the clinic as a tax deduction.

The CRA's list of allowable medical expenses includes ECGs, laboratory procedures or services including necessary interpretations, as well as testing like spirometry and tonometry when provided by a qualified practitioner.

Canada Revenue Agency spokesman David Walters confirmed that tax filers are not required to know whether an expense has already been paid for by the province.

Health spending accounts generally follow the federal government's list of allowable expenses. While employers pay the cost, they are allowed to write off the expense against earnings, said Grant Popowich, a partner with Grant Thornton  LLP in Edmonton.

Issues around over-testing were also raised in a lawsuit filed earlier this year. Copeman launched a suit against two of its former doctors, one of whom is the clinic's former medical director.

The clinic alleges the doctors are now unfairly competing with Copeman at their newly opened facility. The doctors deny the allegations. In a counter suit, the doctors allege the clinic subjected patients to unnecessary testing in doctors' names, without their knowledge.

The clinic denies the allegations. Its filings claim, "at no time did Copeman direct that any physician order medically unnecessary tests."

None of the allegations have been tested in court.


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