The Financial Services Regulatory Authority of Ontario (FSRA) says it will continue in 2021 and 2022 to oversee service providers’ billing practices and business systems and practices, and take action against those found to be non-compliant.
FSRA regulates the billing practices of service providers licensed by it with the aim of helping to maintain fair and reasonable auto insurance rates for consumers.
“FSRA’s supervision focused on ensuring service providers licensed by FSRA to direct bill auto insurers for statutory accident benefits complied with regulatory requirements,” they write. “With over $600-million in claims and 46,000 new claimants last year, this sector requires effective supervision to reduce fraud so that auto insurance rates don’t increase unnecessarily.”
The 2021-2022 Health Service Provider Supervision Plan states that there are over 5,000 active service providers licensed in Ontario. A licensed service provider is a business that provides goods and services to Statutory Accident Benefits Schedule (SABS) claimants, submits invoices on behalf of claimants and is paid directly by the insurer.
The plan says 88 per cent of service providers resolved deficiencies identified in previous reviews. FSRA also says it reviewed the 242 sanctions issued by service providers’ regulatory colleges and found two licensed providers that were billing using the credentials of a sanctioned professional – the two cases were escalated to licensing and enforcement. FSRA also revoked the licenses of 174 service providers that did not file their annual information returns or mandatory regulatory fees more than once.
As of December 2020, FSRA adds that it has obtained access to the data available in the Health Claims Database (HCDB) and plans to use the new data going forward to validate information reported in annual information returns that all licensed service providers need to file, and to validate that licensed service providers are not billing using the credentials of sanctioned professionals.