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Doctor didn't act alone: clinic

Other MDs billed for work by nurse practitioner; effort to challenge the system

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A Winnipeg doctor who was disciplined recently for billing Manitoba Health for patients seen by a nurse practitioner did not act alone, says the owner of the clinic where he worked.

Daren Jorgenson, owner of Four Rivers Medical Clinic, said other physicians at his clinic were doing the same thing as he challenged the province to reform its billing system.

Earlier this month, the College of Physicians and Surgeons of Manitoba publicly censured Dr. Richard Letkeman, a former Four Rivers doctor. Between November 2010 and April 2011, the college said, Letkeman billed the province nearly $40,000 for patient house calls taken by a nurse practitioner working under his supervision at the clinic.

In an interview, Jorgenson alleged Manitoba Health was long aware of the clinic's practice and admitted he had been "pushing the envelope" with provincial bureaucrats in a bid to get them to accept a less expensive fee-for-service regime for nurse practitioners.

He said he bombarded department officials with emails, challenging them to issue him a "cease and desist" order so he could challenge the existing billing system in the courts. "For two years, they never did anything," Jorgenson said in an interview this week.

Asked for its reaction, Manitoba Health reiterated its position responsibility for fee-for-service billings rests solely with the physician submitting for payment. The department did not address the allegation it knew other doctors at the clinic were submitting bills for the nurse practitioner's house calls.


"Manitoba Health has recovered the amount inappropriately billed by the physician in this case before sending the case to the Winnipeg Police Service for investigation. It would be inappropriate for us to comment any further," a department spokeswoman wrote in an email.

Winnipeg police have not responded to a request on whether it is actively investigating the matter.

Four Rivers operates clinics on Main Street and Broadway as well as a house-call service that involves as many as four physicians visiting patients on a given day.

Jorgenson said most of the patients his physicians visit could be treated by a nurse practitioner at a lower cost to the health system. He applauds the government for establishing Quick Care clinics staffed by nurse practitioners and registered nurses. But he believes it could be doing much more to lower patient care costs.

"It's really important for the future. If we can't control health-care costs through innovative means, we're (doomed)," he said.

Jorgenson also blasted the College of Physicians and Surgeons for barging into what he said was a simple billing matter between his clinic and Manitoba Health.

He said during its investigation of Letkeman, the college went through the records of patients visited by the nurse practitioner with a fine-toothed comb -- and even interviewed some about their care -- but found nothing amiss.

He described the college's censure of Letkeman as an exercise of doctors protecting their own turf.

Meanwhile, he said his clinic is having to turn away scores of house-call patients a day due to lack of staffing.

The college's registrar, Dr. Bill Pope, could not be reached for comment Wednesday.

The nurse practitioner who went out on the doctor-supervised house calls was equipped with a Health Canada-certified camera system that would allow a physician back in the office to log in and listen to a patient's heart, check a patient's throat and ears and participate with the patient and nurse practitioner in a live three-way conversation, Jorgenson said.

In its investigative report, the college said while Letkeman tested the equipment in the clinic, it was never used on a house call.

Jorgenson disputes this.

"Was it used all the time? No. Was it available to be used? Yes. Was it used sometimes? A hundred per cent," he said.

Four Rivers doctors -- fearful for their licences -- no longer submit bills to government for nurse practitioner visits, Jorgenson said.

The nurse practitioner employed by the clinic continues to do house calls, he said, but now visits wealthy Winnipeggers who pay for the service.

While the college publicly censured Letkeman, he continues to practise in the city.

Republished from the Winnipeg Free Press print edition February 20, 2014 A3

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