Ontario’s Financial Services Regulatory Authority (FSRA) is ramping up efforts to address compliance issues in the health services sector with a new three-year plan to protect motor vehicle accident victims and ensure transparency in billing practices.
The 2024-2026 Health Service Provider Supervision Plan targets specific areas of non-compliance to strengthen the oversight of claims under Ontario’s auto insurance framework.
Under the Statutory Accident Benefits Schedule, health service providers are allowed to bill automobile insurers directly for medical and rehabilitative expenses incurred by motor vehicle accident victims.
To safeguard this process, licensed providers are required to follow strict standards and procedures that aim to prevent fraudulent or inconsistent billing, ensuring benefit dollars are used effectively for patient care and recovery.
FSRA executive vice president for market conduct, Huston Loke said that the plan's purpose is to protect the rights of accident victims while promoting regulatory compliance.
"This new supervision plan for 2024-2026 targets specific areas to support a fair, transparent, and compliant health service provider sector," said Loke.
Over the past two fiscal years, FSRA conducted three supervision initiatives and found a high level of non-compliance among health service providers. Despite ongoing efforts to raise awareness of their regulatory responsibilities, many providers continued to fall short of the required standards.
The 2024-2026 supervision plan outlines three primary areas of focus. FSRA plans to review compliance among the top-billing health service providers listed in the Health Claims for Auto Insurance (HCAI) system, particularly those who have not been previously evaluated by the regulator.
It will also examine how insurers and health service providers manage preferred provider network agreements to ensure customers are treated fairly and regulations are followed.
In addition, FSRA will monitor health service providers whose HCAI rosters include sanctioned practitioners, aiming to identify and address any unauthorized activities within the claims system.
Aside from its supervision efforts, FSRA is reviewing the broader Health Service Provider Framework as part of Ontario’s initiatives to improve the auto insurance system.
The regulator has already begun implementing its 2024-2026 activities and is urging health service providers to familiarize themselves with the new plan and related resources to ensure compliance.
How will FSRA’s heightened focus on compliance shape Ontario’s auto insurance and health services sectors? Share your perspective in the comments.
