The Collège des médecins has again suspended the head of a Montreal health clinic for failing to comply with an investigation into extra billing at his medical centre.
Family doctor Albert Benhaim, director of Group Santé Physimed Inc. in St-Laurent, who has been barred from practising medicine since last October, has now lost his license indefinitely.
The Collège barred Benhaim after finding him guilty of willful and “abusive” obstruction of an investigation.
In its ruling made public last week, the Collège disciplinary committee noted that Benhaim’s obstruction started six years ago when the provincial health insurer, the Régie de l’assurance-maladie du Québec (RAMQ), launched an investigation into his practice.
Benhaim says he’s under no legal obligation to produce his clinic’s invoices for public scrutiny. In 2014, he filed a suit in Quebec Superior Court against the Collège and RAMQ seeking $2.5 million in damages. That suit has not been heard yet.
The Collège’s move to strip Benhaim of his medical licence came just days before Health Minister Gaétan Barrette announced a ban on extra billing — or “user fees” — for procedures covered by medicare.
The decision to scrap user fees as of January — for eye drops or opening a file, for example — came after Ottawa threatened to cut health transfer payments to provinces allowing extra billing.
Benhaim’s saga with Quebec’s health regulators started when a woman seeking a family doctor was charged $340 at Physimed for a checkup and a battery of laboratory tests, including blood and urine.
RAMQ opened its investigation on July 30, 2010.
In court documents, Benhaim explained he founded Physimed in 1998, and in 2005 the centre became part of the city’s network of clinics created by the Health Department to reorganize front-line medical services in Montreal.
The clinic offers multiple integrated services under one roof: family doctors, specialists, nurses, radiology and imaging, physiotherapy, psychological and nutrition care, as well as laboratory blood analysis contracted out to Laboratoires CDL.
It now has 300,000 patients, of which about 65 per cent opt for the convenience of getting laboratory work done on the spot rather than going to a hospital. These services are not covered by medicare in a clinic setting, Benhaim noted, and fees patients pay out of pocket usually are reimbursed by their insurers.
But RAMQ disagreed about the legality of the fees and demanded Benhaim hand over the invoice CDL charged the clinic that led to the $340 fee charged to the patient. Benhaim refused, saying the information is part of a commercial agreement in a competitive field and as such is confidential.
In the following months, RAMQ took legal measures against the clinic. When that failed, in 2012, it went after the laboratory.
Physimed then sent RAMQ a cease and desist letter, which crossed the desk of Charles Bernard, head of the Collège and also a RAMQ administrator. Bernard sent the letter to the Collège board of investigators, who opened a file in January 2013.
Investigators asked for three documents: a copy of the $340 bill the patient paid; a copy of the invoice from CDL for the patient’s lab analysis; and a copy of an agreement between the centre and the pathology lab at Sacré-Coeur Hospital, where some lab work is done.
Benhaim refused. He also invested a Physimed administrator with full authority to respond — or not — to the investigators’ demands.
In January 2014, the Collège gave Benhaim a final ultimatum: produce the documents by February or face charges of obstruction.
Benhaim responded by asking Quebec Superior Court to declare all demands for invoices and documents illegal, null and void. He is also seeking $2.5 million in damages.
In October 2015, the Collège’s disciplinary committee revoked his licence.
“To this day we don’t have the documents,” Bernard told the Montreal Gazette.
He noted the Collège has long opposed billing practices where “patients are taken hostage,” such as when they are billed $200 for eye drops that cost a few cents before undergoing an exam.
“We have to take it case by case,” he said. “This worries us enormously.”
However, he said the Collège’s hands are tied when investigators are denied access to third-party agreements pertinent to investigations.
The Collège has asked the provincial health and justice departments, as well as the Office de profession du Québec, to facilitate access — but “that was six years ago, and we’re still waiting for an answer.”
“If you have nothing to hide you open the books,” Bernard said. “My interpretation? Dr. Benhaim prefers to stop practising medicine so his company can continue functioning.”
Benhaim did not respond to several phone calls and an email requesting an interview.
Daniel Granger of ACJ Communication, a corporate communications and public affairs consulting firm, said Benhaim was advised by his lawyers not to speak to reporters while his case is tied in court.
Aside from the suspension, Benhaim faces further sanctions before the disciplinary board at a date still to be determined. They may include fines or the loss of his medical licence to practise in Quebec.
Last week he sent his patients an email saying he misses them and he misses practising medicine. He also explained why he refused to hand over the invoices:
“Physimed refused on the grounds that these agreements are confidential and more so because these services, which are not covered by medicare, do not fall under the RAMQ’s jurisdiction.”
