Ombudsman Raymonde St. Germain says what occurred at the McGill University Health Centre three years ago should never be allowed to happen again.
A woman from Kuwait had flown in for surgery at the Royal Vic, a service for which the hospital was paid $200,000.
But many of the details surrounding this visit are still under dispute.
The ombudsman says the money paid out to cover the treatment was passed through a private company called Montreal Medical International (MMI), which she says may have been created to circumvent Quebec's regular health care structure.
"It appears that it is that because it got around the system by creating this company," says St. Germain.
But the MUHC says MMI was created to deal with the hospital's overseas work and was not involved with the funds for this patients' treatment.
"The MUHC cashed the check and we deposited it into the accounts of the MUHC," says CEO Normand Rinfret.
The ombudsman also says the Kuwaiti patient bumped out Quebecers who had been waiting for surgery because there were 38 people on the cardiology wait list on the day the woman was treated.
"Perhaps if she wouldn't have come, 37 would have been on the list."
But, the hospital says those other patients could not have been seen due to budget restrictions, and that the money from the Kuwaiti patient would have allowed more people to be care for.