MDs getting paid up to $350 per patient for medical marijuana referrals, despite bans

TilrayPhotos of operations at Tilray, one of Canada's medical cannabis licensed producers. The operation on Vancouver Island has been shipping BC-grown medical marijuana to Canadian patients for whom it has been prescribed since April 28, 2014.

By Tom Blackwell 
TORONTO — Doctors and clinics are receiving fees of as much as $350 per patient from medical-marijuana producers eager to snag customer referrals, despite professional rules in some provinces that explicitly outlaw such payments, producers say.
Physicians working under federal law do not prescribe a specific brand of cannabis, but some try to steer patients toward particular cannabis suppliers – and expect reimbursement, industry members report.

Doctors sometimes tell companies the money is to subsidize the cost of verifying patient information, or providing marijuana-related services to patients not covered by medicare.
But one government-approved pot grower charges the payments are essentially “kickbacks.” Professional ethics rules in most of Canada prohibit physicians’ receiving “rebates, fees, gifts or other incentives” in return for patient referrals.

Nanaimo, B.C.-based Tilray showed the National Post copies of unsolicited invoices it has received from two individual doctors, three clinics and two “patient aggregators” that work with health professionals, requesting payments or even a share of cannabis sales.
Most ask for $50 per patient, but others have verbally requested as much as $350 – while some aggregators propose deals giving them up to 20 per cent of a producer’s revenue, it says.

The College of Physicians and Surgeons in both Ontario and British Columbia have issued statements saying it is unacceptable for doctors prescribing marijuana to charge fees to either patients or licensed producers. The marijuana approvals they sign for patients are akin to writing drug prescriptions, which is a government-insured service, stress both regulators.
“The College hasn’t heard anything about physicians allegedly receiving ‘kickbacks’ from marijuana producers,” said Susan Prins, a spokesman for the B.C. agency.

“(But) this practice would absolutely be in contravention of the professional standard on conflict of interest. If admitted or proven, a disciplinary consequence would be likely.”
Health Canada, which accredits cannabis producers, is “actively looking into the issue,” spokesman Andre Gagnon said in an email.
The department “is concerned about reports that some physicians may be charging fees,” he said. “Health Canada expects that all licensed producers will adhere to a high standard of ethical conduct.”

One patient advocacy group says it has fielded numerous complaints from people who have been directed by a marijuana-prescribing doctor to a specific producer. Most users would prefer to shop around for the supplier that best meets their needs, said Laurie MacEachern of the Medicinal Cannabis Patients’ Alliance.

‘It’s very concerning. It taints the whole industry. We should be holding physicians to a higher standard’

“This is a huge barrier for us,” she said. “They (doctors) will hook you up with licensed producers that support them in whatever way … Now you’re tied to that producer, you can’t do anything else, you can’t go to another one.”
None of the clinics, doctors or intermediaries mentioned in invoices and correspondence shown to the Post by Tilray responded to requests for comment.

Some noted in that correspondence, however, that some of the services they provided to patients – such as how to use marijuana vaporizers – were not funded by medicare. Others cited the cost of verifying patient information for producers.
Under the new federal system that went into effect just over a year ago, patients obtain an approval for medicinal marijuana from a doctor, then use that approval to order cannabis from one of about 25 licensed producers.

Added to the mix are groups that Greg Engel, Tilray’s CEO, calls aggregators, middlemen who sign up patients and then direct them to certain physicians and marijuana producers with whom they have arrangements.
Some companies have no compunction about offering cash incentives to clinics, one doctor’s office suggests in a letter to Tilray.
“We have been contacted by a number of licensed producers who would like to ‘purchase’ our patients for significantly higher amounts,” a B.C. clinic wrote to the company, saying it wanted only $50 per patient to cover uninsured costs.