The Yukon government says it does not require complete patient charts from physicians for billing purposes, following claims from a local psychiatrist that he’s being asked to give over sensitive information in order to be paid.
But Dr. Armando Heredia insists he has nearly 300 outstanding requests — he calls them yellow sheets — from the insured health office asking for medical records that include “full notes, full assessments, full charts,” with more coming in all the time. He said the problem ramped up about five years ago.
Heredia said he has refused to share complete medical records with the government, and is therefore not being paid for many of the services he provides. He said he’s now owed more than $100,000.
“Patients have no idea that their doctors are being put under pressure to provide private medical information to make a living,” he said. “Why do you need to know somebody’s most intimate secrets, most intimate feelings, in order to get the doctor paid?”
Shauna Demers, director of insured health with the Department of Health and Social Services, said that when physicians bill the government, they must provide the patient’s health-care number, a code corresponding to the patient’s diagnosis and a fee code indicating how much they should be paid for different services.
They must also provide referral letters from general practitioners, though Demers said treatments, conditions and specific concerns about a patient’s health should be redacted from those letters.
But if information is missing from billing claims, or if there is anything unusual about them, the government can suspend the claims until the physician submits additional information.
That’s where Heredia and Demers disagree about what insured health requires.
Demers said the government generally wants evidence that a patient was referred to a consulting physician, like a psychiatrist. That could include a written report from the consultant to the referring physician, with sensitive information deleted.
“It’s just confirmation that they were seen by the one provider and referred to another,” she said. “We have never requested entire patient charts.”
But Heredia disputes that, saying there is no indication in the requests from insured health that certain information should be redacted. He said that even if physicians are allowed to redact sensitive information, they’re not being told how.
“Have they actually sent something out to the doctors about how you’re supposed to do it?” he said. “The answer would be no, because I’m probably the one they would send it to first.”
Health department spokesperson Pat Living confirmed that it is physicians’ responsibility to redact private information.
“It’s up to the physician to ensure that they’re only providing us with the information we need,” she said.
Insured health can also conduct audits of physicians’ records. Demers said all physicians will be audited from time to time, especially when they’re new to the territory, to make sure they understand how the system works.
But they will also be audited if there are “anomalies” in their billing claims, she said — for instance, if a physician is billing especially high fee codes compared to others that provide similar services.
Heredia said he was audited twice soon after he arrived in the territory, around 2003. Last year, he received another audit request, but he said it was cancelled before it happened. He claims he would have refused to allow government officials to look through his records.
But he said there’s nothing unusual about his billing. He believes he’s being targeted because he has refused to turn over complete medical records to the government.
“In the end, I’ve accumulated so many (yellow sheets) because I don’t comply, and more than likely I receive more than most because I don’t comply,” he said.
He said other physicians have told him they avoid billing certain codes altogether, for fear they will produce yellow sheets.
“I think the system has caused the physicians to modify what they bill in order to get paid,” he said.
Dr. Alison Freeman, president of the Yukon Medical Association, which represents local physicians, told the News in a statement that the confidentiality of patients’ health information is “paramount and fundamental to the doctor-patient relationship.”
“The YMA will continue to advocate for the appropriate balance between the confidentiality of medical records and the information required by government to ensure fiscal responsibility.”
Still, Demers insists that the Yukon government’s practices are compliant with Yukon’s Health Information Privacy and Management Act (HIPMA), which came into force in August 2016.
HIPMA states that a physician can disclose a patient’s personal health information to the government without the patient’s consent “to the extent necessary for payment for health care or other related goods, services or benefits provided to the individual.”
Demers said the Yukon legislation is “not unlike other jurisdictions in Canada.”
A spokesperson for B.C.’s Ministry of Health explained by email that “In most cases, patient charts are not required for billing — however, they may be required if there is an audit of a physician’s billing.”
Diane McLeod-McKay, the Yukon’s information and privacy commissioner, said HIPMA is complicated, but it does lay out very specific instances in which personal information can be shared without a patient’s consent.
“It’s supposed to maximize privacy protection,” she said. “But it also has to be balanced against the system’s need to have information.”
She said the act is a good piece of legislation, but “there’s still a lot of work to be done to improve the level of compliance in the Yukon.”
McLeod-McKay is currently investigating complaints about the collection of medical information by insured health, and she’s urging others with concerns to contact her office.
“I think my biggest concern here right now is I would be very concerned if people suddenly became afraid to go to their doctor,” she said.
But Heredia lays that responsibility at the government’s doorstep.
“Fix the system so people can be comfortable seeing their doctor.”
Contact Maura Forrest at firstname.lastname@example.org