CRA accepts that there can be a double supply of a physician’s services

P-238 discusses fee sharing in the context of a practice involving a principal practitioner and a locum, and involving a principal practitioner and contract associates, and states:

[Where there is a] bona fide arrangement to share fees, the CCRA will not consider the payment by the associate to be in respect of a supply of administrative services made by the principal. The underlying characteristic of this arrangement is an apportionment of the fee for the health care service rendered to the individual between the parties. Thus, for purposes of the ETA, the amounts apportioned between the two parties are not subject to tax.

CRA indicated that the view underlying this policy is that where one person (A) supplies exempt health care services to patients and engages a medical practitioner (B) as a sub-contractor to render those services to patients, then A’s supply to patients can be exempted (for example, under Sch. V, Pt. II, s. 5), and B’s supply to A can also be exempted under s. 5, as there, as well, there is “a supply of a consultative, diagnostic, treatment or other health care service that is rendered by a medical practitioner to an individual.” It further stated:

The CRA considers that some exemptions can apply twice to the same service as the requirement is that the service be rendered by a medical practitioner or a practitioner as defined in section 1 of Part II of Schedule V.

Neal Armstrong. Summary of 7 April 2022 CBA Roundtable, Q.5 under ETA, Sch. V, Pt. II, s. 5.