Vancouver Coastal Health is reviewing allegations that some cardiologists are routinely and inappropriately billing for procedures they do not perform.

The allegations, outlined in correspondence obtained by The Globe and Mail, relate to a procedure called an intra-operative transesophageal echo. Commonly referred to as a TEE, the procedure involves inserting a probe into the esophagus to monitor a patient's heart during surgery.

According to a 2012 letter from the heads of the regional cardiac program – run by the Vancouver Coastal and Providence health authorities – some doctors at St. Paul's and Vancouver General Hospital were at the time billing an "unanticipated" procedural fee of $142.76 each time a TEE was carried out, "even though the procedure is actually performed by the anesthesiologist and the liability for it rests with the anesthesiologist."

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The letter, sent to senior managers at the health authorities, recommends that billing practices be standardized and the "standing arrangement should be changed or possibly terminated."

But, according allegations in an unsigned letter that accompanied the 2012 document obtained by The Globe and Mail, those recommendations were never carried out, and doctors have billed nearly $4-million for procedures they did not perform.

Vancouver Coastal Health spokeswoman Anna Marie D'Angelo said the health authority had recently received the same correspondence as The Globe and Mail obtained.

Vancouver Coastal Health is looking into the allegations, but a preliminary review indicates the amounts are much smaller than suggested, running to the "tens of thousands" rather than millions, Ms. D'Angelo said.

And the fact that a review is under way should not be interpreted as an indication of wrong-doing, she said, adding that it would be premature to suggest anything inappropriate had taken place.

"But we are concerned about what has been said about the billing practices and the internal review is going to look at that," Ms. D'Angelo said.

She was unable to say when the review would be complete.

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The correspondence concerns heart operations at St. Paul's, which is part of the Providence Health Care authority, and Vancouver General Hospital, which falls under Vancouver Coastal Health.

In 2012, managers of the regional cardiac program were looking for ways to offset the loss of revenue expected when some operations shifted from the Lower Mainland to Kelowna, where a new cardiac centre opened last year.

According to a 2011 Vancouver Coastal Health blog, about 270 cases a year would move from the Lower Mainland to Kelowna.

"This future reduction in activity for [Vancouver Coastal Health and Providence Health] is a challenge and creating anxiety in the hallways and operating rooms across [Vancouver Coastal Health]," the blog said.

"Each site currently does 883 cases each year for a total of 1,766 surgeries. Next year, collectively between the two sites, we will do 270 cases fewer. … Extracting associated financial costs out of the system – around $4-million – is a very real challenge, but this money needs to be redirected to support the Kelowna program," the blog noted.

Regional cardiac program managers reviewed billing and procedures related to TEEs as part of a cost-savings effort and discovered the unanticipated fees.

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Ms. D'Angelo said the health authority's review will look at billing codes for the procedures and how they are handled at the two sites, but said the heart doctors are still involved with TEEs even if they do not perform them.

"The cardiologists do look at those TEE scans and they review the images and produce a report," she said.

According to a 2012 letter from the heads of the regional cardiac program – run by the Vancouver Coastal and Providence health authorities – some doctors at St. Paul's and Vancouver General hospitals were billing an "unanticipated" procedural fee of $142.76 each time an intra-operative transesophageal echo, commonly referred to as a TEE, was carried out.

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