The CBC has uncovered evidence that Copeman Healthcare Centre in Calgary is trying to purge patients who can no longer pay the clinic's fee.

Fee-paying patients at the clinic who lose their jobs, or their work benefits, are regularly told their options for continued care are to keep paying fees or get a referral elsewhere.

This despite Alberta law that says access to insured services like doctor visits can't be tied to fees.

Until last year, more than 100 employees of Athabasca Oil, a large client of Copeman, had a benefits package that covered the clinic's annual membership fees. Those amount to more than $3,000 annually for an individual. The cost is higher in the first year, though corporate clients typically enjoy a discount.

Last Autumn, Athabasca cut staff and the benefits for remaining employees, meaning the private clinic's fees were no longer covered for most workers.

In response, Rick Tiedemann, head of business development for the chain of four private clinics, warned Calgary staff not to discuss the patients' option to continue to see their doctor without paying.

"Please DO NOT discuss MSP options or other variances of our programs/fees," reads Tiedemann's email.

"MSP" is lingo that refers to British Columbia's Medical Services Plan, essentially its provincial health-care coverage, sources at the clinic say. Copeman's head office clinic is in Vancouver.

"Simply refer them to Carlene for a conversation that will allow them to explore their care/fee options," the memo reads.

Read the full document below

Doctors at Copeman bill Alberta Health for patient visits

Though Copeman is a private clinic, doctors bill Alberta Health for patient visits. The company website says the fees it levies are "strictly for non-insured health services," like visits to a dietitian.

The Athabasca clients typically enjoyed full "life plus" memberships at the clinic, which included family physician care for themselves and their families.

In an ongoing investigation, the CBC has interviewed more than half a dozen current and former Copeman staff.

The sources say the Carlene named in the memo refers to Carlene Clemence, the Calgary clinic's manager of business development.

They also say that both business development staff and those in administration, who dealt directly with patients, were instructed never to volunteer the option of continuing to see their family doctor for patients no longer paying clinic fees.

If patients seemed especially well informed of their rights, one source said, the clinic could tell them it would consult their physician and go from there.

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)

Cannot bill for medically necessary care

"What the Canada Health Act does say is that you can't have extra billing or user charges for medically necessary care, which is what the clinic is doing," said Colleen Flood, a professor and expert in health law and policy at the University of Ottawa.

Flood noted that, in her opinion, the membership fees Copeman charges already cross that line. But she said that this is federal legislation, and enforcement has largely been left to the provinces.

Andrew MacKendrick, press secretary to federal Minister of Health Jane Philpott, said the issue is "under provincial health jurisdiction."

"If a fee is a condition for receiving insured services from an opted-in physician, then what Copeman is said to be doing violates the Alberta Health Care Insurance Act," said Erin Nelson, a professor and expert in health law at the University of Alberta.

"But the act doesn't specify what information must be provided to patients. I don' t think the act is that specific. But I think from an ethical and professional standpoint it's a concern."

The CBC attempted to contact Clemence and Tiedemann, but neither responded to requests for an interview.

Copeman CEO Chris Nedelmann declined to comment.

Alberta government investigating Calgary clinic

The Alberta government is auditing both the Calgary and Edmonton clinics. The Special Investigations Unit, part of Service Alberta, is also conducting a probe of the business.

The CBC investigation found that, until last year, Copeman had been billing Alberta Health for medical tests many of its own doctors believed were unnecessary.

The bills to patients are also structured so that the cost of a Copeman membership can be expensed through health-spending accounts offered by some employers. The cost of these accounts to employers is a tax deduction, so the expense of Copeman's fees is also defrayed by the federal government.

Copeman's Calgary clinic has been at the centre of the CBC's investigation, but sources say most policies — including mandates to subject all patients to the same range of medical tests — came from the head office in Vancouver.

A spokeswoman for B.C. Health Minister Terry Lake said in an email that the government performs audits of clinics like Copeman where necessary. She did not respond when asked directly if the B.C. government is auditing or considering auditing Copeman's two Vancouver clinics.

But pressure to do so is building.

NDP MLA Judy Darcy, the official opposition's spokesperson for health, issued a letter to Minister Lake urging him to follow the lead of officials in Alberta.

"The Alberta clinics are directed from the head office in Vancouver," her letter reads. "We think this should be the impetus to lead your ministry to launch a thorough investigation into the practices of the B.C. clincis."