Regulator suspends, revokes licences of 170 health service providers

Ontario’s financial services regulator has suspended or revoked the licences of 170 health service providers (HSPs) who failed to comply with their annual business reporting obligations.

A total of 118 HSP licences were revoked and 52 were suspended, the Financial Services Authority of Ontario (FSRA) reported Tuesday.

“In 2023, FSRA took action against health service providers (HSPs) who did not file their annual information return and pay their licensing fee,” FSRA said on its website. “Although the regulator informed these individuals about potential enforcement action and followed up with them multiple times, they failed to comply.”

Service providers with suspended or revoked licences may still provide care to motor vehicle accident victims but cannot receive direct payment from insurance companies, FSRA explained in a press release. Instead, claimants will receive money from their insurance companies to reimburse those service providers.

To maintain a licence, each year HSPs are required to complete a questionnaire known as the annual information return (AIR), FSRA told Canadian Underwriter. The AIR collects information about the service provider’s business systems, practices and controls, in connection with billing for listed expenses in the previous calendar year.

It also includes the list of all facilities, the address and Health Claims for Auto Insurance (HCAI) registry number(s) of all facilities enrolled in HCAI as of Dec. 31, and the number of unique statutory accident benefits claimants during the reporting period.

This information helps FSRA conduct market analysis, risk assessment and oversight of the service provider sector. At the same time, licensed service providers must pay an annual regulatory fee (ARF), which covers the yearly cost of regulating the service provider sector.

FSRA (CNW Group/Financial Services Regulatory Authority of Ontario)

“It’s essential that health service providers comply with their legal annual reporting requirements so we can better protect consumers and help maintain fair and reasonable auto rates,” Huston Loke, executive vice president of market conduct at FRSA, said in the release. “This is crucial information as it informs our supervision plan for the sector and identifies trends that could lead to consumer risks and areas of concern.”

HSPs who wish to lift the suspension from their licence must file all overdue AIRs and pay all ARFs, FRSA told CU.

“Service providers with suspended licences who do not take any action while in a suspended status will have their licences revoked by FSRA at a near date in the future,” FSRA said. “Service providers with suspended licences who wish to avoid revocation need to reinstate their licence or submit an application to surrender their licence. Service providers whose licences have been revoked will not be able to have direct billing with insurers for listed expenses.”

The suspension or revocation of HSP licences is a big part of FSRA’s supervision plan for the sector, the regulator said.

In November 2022, FSRA released a two-year supervision plan aimed at protecting consumers’ rights by delivering supervision and education to higher-risk auto insurance HSPs. Higher risk HSPs were described as those “more likely to either bill for services not provided, or bill for services that are not provided by a regulated health professional,” Beata Morris, FSRA’s director of market conduct for P&C insurance, told CU at the time.

As part of the plan, HSPs that receive direct payment from auto insurers for benefits claimed under the Statutory Accident Benefits Schedule (SABS) could be selected by FSRA for examination under one of the three streams:

• Insurer-initiated examination reviews – If you are a service provider conducting examinations to help an insurer determine if an insured person is or continues to be entitled to a benefit.
• Focused compliance reviews – If you are a service provider who has never been examined by FSRA.
• Sanctioned practitioner reviews – If you are an HSP with a sanctioned practitioner listed on your HCAI roster.

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