In her annual report, Kim MacPherson raised questions about the amount of money being paid to physicians and specialists, saying New Brunswick's medicare payments last year were more than $553 million — but only 53 per cent of those payments were audited.
MacPherson said 16 doctors received more than $1 million each from medicare last year, including an ophthalmologist who received over $1.6 million. That compares to a Health Department annual salary estimate of $291,418 for general practitioners and $420,977 for the average specialist.
"The observations on payments to doctors are intended to highlight unusual items that, in our professional opinion as auditors, may warrant further investigation by the department, MacPherson said in her report, calling on the government to audit all medicare payments.
She also flagged concerns about double-billing, whereby doctors charge medicare and WorkSafeNB, which oversees workers' compensation in the province, for the same procedures on the same patients.
"We were told there are some doctors who repeatedly appear on that list to be double-billing," she later told reporters.
"It could be happening inadvertently or advertently. I have no idea."
MacPherson said doctors who overcharge medicare don't face consequences, even though the Health Department has the power to revoke a doctor's billing privileges in such cases.
Anthony Knight, CEO of the New Brunswick Medical Society, said he doesn't believe doctors are intentionally double-billing. He said it's likely a "misunderstanding" and a better billing system would improve the situation.
"Doctors work daily with medicare to address anomalies or confusion that exists about interpreting complex language in the fee schedule that doctors are left to interpret and apply in their practice," he said.
"Sometimes there are disagreements on how the interpretation is applied with medicare."
Knight added that medicare payments to doctors don't just cover their salaries — they account for other costs as well, including the purchase of equipment.
Health Minister Hugh Flemming said he was still reviewing MacPherson's report but promised to quickly crack down on the practice of double-billing.
"It should be looked into immediately," he said. "Double billing is inappropriate."
MacPherson also specifically highlighted payments to some radiologists as a concern, saying they appear high and aren't subject to regular payment controls like other specialties.
In one case, a radiologist received $6.3 million in medicare payments over the past five fiscal years, she said.
Knight said the society has been working with the government on billing by radiologists for the last 10 years but little progress has been made.
"Radiologists are billing using paper and the rest of physicians have been billing electronically since the 1980s," Knight said.
"We are waiting for the government to come forward with a system that automates the billing system."
MacPherson's report said the Health Department expects to have a new billing system for radiologists in place by April.
She also said there were cases of conflict of interest in the awarding of contracts between 2005 and 2011 for the creation of an electronic health records database. The system is intended to allow the health care system easier access to a patient's medical record.
Her report said the Health Department contracted consultants who managed their own contracts and could access competitor information. The consultants were also part of committees that recommended which consultants got work, she added.
MacPherson also said the government did not comply with its own procurement policy in 57 of the 289 e-health development contracts signed between 2005 and last year.
She said in some cases, the work contracted to consultants could have been by department staff at a lower cost.