British Columbia is close to the front of the pack when it comes to private medical clinics charging extra user fees to patients, according to a survey conducted by advocates for public health care.

The Ontario Health Coalition study alleges there may be improper billing at 30 of 34 private clinics in B.C. and at a total of 88 clinics across the country.

According to the coalition, only Quebec — at 31 clinics — had a higher number of facilities with suspect billing.

These clinics appear to be charging patients for services that are already covered through the public health-care system, the authors say.

"[These fees] interfere with the whole premise of Canadian public health care, which is of course that when we need care we should be able to get it, no matter how much we can afford to pay or not," said Adam Lynes-Ford of the B.C. Health Coalition, which sponsored the study.

"In this case, patients are paying sometimes huge amounts of money — up to five times more than the cost of those services in the public system."

For example, private B.C. clinics billed patients between $650 and $995 for MRI scans and more than $8,000 for knee surgery to repair a torn ACL, according to the study. In a handful of cases, those clinics also asked people for their health cards, raising the possibility that both MSP — and individual patients — are being billed for the same services.

The Canada Health Act specifically forbids patient payments for "medically necessary" services, and the coalition is calling for the user fees to be investigated as violations of the act.

Dr. Brian Day's surgery clinic is at the centre of a long-running legal battle over private health care in B.C. (Darryl Dyck/The Canadian Press)

The issue of billing for private health-care services is currently the subject of a long-running legal battle between the B.C. government and Dr. Brian Day, the owner of Vancouver's Cambie Surgery Centre

A 2012 provincial audit of Cambie Surgery turned up a half-million dollars worth of illegal billing.

Both the provincial and federal governments have the responsibility to protect patients from improper billing, according to Lynes-Ford.

But he also believes the provincial government can also address the issue by improving the service British Columbians get within the public system.

"We know that in B.C. we faced, in some cases, some of the longest waits for procedures in the country. Some patients feel trapped and so they're going to private clinics to get the care they need in a timely way, so they're really getting taken advantage of that," he said.

In an email, a spokesperson for Health Canada says these types of violations should be reported to the provincial government, because the federal government has no authority to investigate allegations of extra billing.

"When Canadians pay for their health-care services through their tax dollars, they should not be asked to pay again, by way of user fees, when they access those services," the statement said.

The Canadian Health Coalition is a public advocacy organization founded in 1979 to promote the preservation and improvement of the universal public health-care system in Canada.