The RAMQ claim made last December was by far the largest in the last ten years. Normally, the amounts claimed vary between a few hundred and a few thousand dollars.
Since 2011, only one complaint has been higher, but it targeted 679 pharmacies, four drug manufacturers and wholesalers.
In this case, the faulty pharmacy obtained its supplies from an unrecognized wholesaler, that is to say not approved by Quebec.
“Only products registered on the List of medications and purchased through a recognized manufacturer or wholesaler can be billed to the RAMQ by a pharmacist for an insured person,” explained the spokesperson for the Régie. , Caroline Dupont, without further details.
Anonymous decisions
Even if the amount is staggering for a single pharmacy, the RAMQ has its hands tied to name the culprit.
In 2016, the former Minister Gaétan Barrette had passed legislative changes to be able to appoint the doctors, pharmacists and dentists who had to reimburse sums at the end of an investigation.
However, when the legislative amendment was to come into force in January 2019, the Federation of Specialist Physicians of Quebec initiated an action against the government to prevent it from revealing the names.
The FMSQ considers, among other things, that this would go against the Charter of Rights and Freedoms, in particular with regard to the protection of the reputation and privacy of its members.
Stretching backrest
Since then, other groups, including the Quebec Association of Owner Pharmacists (AQPP), have become interveners in the litigation.
The latter is still far from being decided. For two years, the parties have opposed each other because the FMSQ notably requested documents from the Council of Ministers.
A recent decision partially proved them right.
Since the case is in court, the AQPP did not want to comment.
The biggest complaints in a year
◆ Pharmacy : $ 17 M
Procurement from an unrecognized wholesaler
◆ General practitioner : $ 1 million
Visits, examinations or consultations
◆ Specialist: $ 559,927
Visits, examinations or consultations
◆ Specialist : $ 356,000
Mixed remuneration for clinical activities
◆ Pharmacy : $ 312,842
Services not rendered concerning 56 medicinal products
QUEBEC HAD PROMISED MORE TRANSPARENCY
Three years ago, the Legault government promised more transparency on the survey results of the Régie de l’assurance maladie du Québec (RAMQ). Since then, there has been very little progress.
In October 2018, a few weeks after her election, the former Minister of Health Danielle McCann said that the government would act, even if it means modifying the laws on health insurance and access to information.
She was reacting to a report from our Bureau of Investigation on investigative reports kept secret by the RAMQ, despite promises to make them public.
“We are the government of transparency. The culture of secrecy as we experienced it with the Liberal government is over, ”said the one who is now Minister of Higher Education.
In December 2018, a first list of doctors, dentists and pharmacists who had to reimburse sums was made public by the Régie.
However, there was no name on this list and very few details on the charges against health professionals pinned by RAMQ investigators.
A list of names of physicians was to be published the following January, but it was postponed due to legal proceedings brought by the Federation of Specialist Physicians of Quebec.
Less details
The list has since been amended to remove certain information. While it initially included the specialty of the physicians involved, such as psychiatry or radiology, these details are no longer in the current list.
We only find the word “specialist” or “general practitioner” when it comes to physicians. We also find the words “dentist” and “pharmacy” for these categories of professionals.
There are also few details on the reasons for the investigation. The terms “visit”, “examination” or “consultation” are thus repeatedly read there.
Impossible to know if it is false invoicing or abusive invoicing.