'Taking advantage' of a dying patient's hopes: Doctor slammed for excessive markups on lab tests

An Alberta doctor who charged a patient tens of thousands of dollars for appointments and tests over four years tacked on excessive markups for lab tests—as much as $250 per test—and billed the provincial health system for some of the same visits. Dr. Bruce Hoffman, a general practitioner in Calgary who practised both traditional and functional medicine, also failed to create records of assessments and treatment for a number of visits that he billed to the Alberta Health System, according to a decision document issued by the hearing tribunal of the College of Physicians and Surgeons and Alberta. The complaint against Dr. Hoffman was filed by the husband of a patient diagnosed with atypical Parkinsonism, who saw Dr. Hoffman starting 2014 and until her death in 2019. During the case investigation and hearing, the husband testified that, after learning of her diagnosis, his wife sought a healthcare professional who would look at underlying causes and give her hope she could recover. The husband told the tribunal that Dr. Hoffman “certainly did give her this idea that recovery or certainly remission was very possible and that was something he knew how to accomplish.” Read: Calgary clinic halts plan to charge fees for faster access to family physician The initial visit with Dr. Hoffman, which included tests, cost the couple $8,000, according to the decision document. Dr. Hoffman charged a similar fee “every few months” for subsequent appointments and testing. However, the husband testified, these fees were “the very cheap part” of their dealings with Dr. Hoffman’s clinic. He explained that while most of the samples were collected at the clinic, the tests were largely done at labs in the United States or in Europe. According to the decision document, the patient paid more than $186,000 for clinic visits. Receipts that were presented as evidence during the hearing showed an additional $86,000 were paid to cover lab tests. Dr. Hoffman’s patient care assistant explained during the hearing that it was the clinic’s policy to add a markup for tests amounting to $250 “plus or minus.” These markups were needed to cover additional costs—such as FedEx shipping, special containers, dry ice and currency conversion—as well as clinic overhead that includes supplies, rent, salaries and technician fees. “The mark-up imposed by Dr. Hoffman were not reasonable handling costs but was rather an attempt to generate revenue to be applied against general operating and variable expenses,” the college concluded. “This was not a ‘one-off unreasonable costs’ associated with a particular product. On the contrary, the average mark-up of $250 applied to each and every laboratory test provided by Dr. Hoffman’s clinic to the patient. Given the scale of the breach of the Standard, the hearing tribunal finds that this amounts to unprofessional conduct.” Read: Making the case for functional medicine in pharmacy The tribunal noted that patients are often vulnerable and will pay for products which they believe will help them in diagnosis or recovery. “The Standard ensures that—regardless of a patient’s willingness to pay unreasonablecosts—they are protected from such a practice,” wrote the tribunal. In arguing the case against Dr. Hoffman, the college’s counsel said the patient had struggled with her diagnosis and with accepting that her disease was ultimately fatal. Her husband and her longtime friend saw the reality, but they stood by her. As you heard [the patient’s husband] say, if it was giving her hope, he wasn't going to deny [the patient] that hope,” the counsel told the tribunal. “But the problem is that the testing and the upcharging that was used by Dr. Hoffman was taking advantage of that hope for profit, which is contrary to what the Standard of Practice of the Council had put in place.” While Dr. Hoffman’s double-billing in this case did not add up to a significant amount—the total billed to the province was $1,389 and the allegation of double billing related only to $840 of this total—the tribunal concluded that this was not an isolated incident resulting from an error but rather a reflection of Dr. Hoffman’s practice of billing a patient for his time while also receiving compensation from the public healthcare system. “Where he billed Alberta Health, the records indicate that he did not reduce his direct billing to the Patient to account for the billing for insured services to Alberta Health,” wrote the tribunal. “That is, the records reflect that this was a true ‘double billing’ for the same visit; Dr. Hoffman charges his patient for his time in accordance with his billing practices while billing Alberta Health for aspects of that same visit. This conduct is inconsistent with the plain language of section 9 of the Alberta Health Care Insurance Act.” The hearing tribunal will decide on penalties at a later date, which had not been set as of this article’s publication date. Read: Physical activity may protect women from Parkinson’s disease too

'Taking advantage' of a dying patient's hopes: Doctor slammed for excessive markups on lab tests

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