Sample - 2016 Service Providers Annual Information Return

Step 1 - Service Provider Annual Information Return (AIR)


Filing the AIR is a mandatory legal requirement under Section 21 of Ontario Regulation 90/14 for all service providers licensed by the Financial Services Commission of Ontario (FSCO).

 

As principal representative you are responsible for ensuring that the service provider submits the AIR and pays the Annual Regulatory Fee no later than March 31.

The AIR is designed to collect information from all service providers licensed by FSCO about their business systems and practices, billing practices, internal controls, and market conditions in the previous calendar year. This information will assist FSCO in its risk assessment and oversight of service providers. Unless otherwise specified, all the questions included in the AIR are mandatory.
 
Service providers that fail to complete the AIR by March 31 may be required to pay an administrative monetary penalty (AMP) or risk the suspension or revocation of their licence. Non-compliance increases FSCO's regulatory costs and directly impacts the regulatory fees paid by service providers.

Reporting period: Unless otherwise specified, for the purpose of this AIR, and all of the questions that follow, the reporting period is January 1 to December 31.
 
To complete the AIR you will need:
 
  • Number of Locations
  • Number of SABS Claimants
  • A valid VISA or MasterCard, or a valid debit card. For regulatory fees exceeding $5,000 a certified cheque or money order payable to the Minister of Finance is required, to be received on/or before March 31.
The AIR will take approximately 30 minutes to complete and will require information at each of the following steps:
 
Step 1 - Welcome (this step)
 
Step 2 - General Information (Service Provider/Business)
 
Step 3 - General Information (Principal Representative)
 
Step 4 - Membership Information
 
Step 5 - General Business Information
 
Step 6 - Business Systems and Practices
 
Step 7 - Billing Information and Practices
 
Step 8 - Suitability

Annual Regulatory Fee:

Upon submitting the AIR you are required to pay the Annual Regulatory Fee.
 
The Annual Regulatory Fee covers the yearly cost of regulating the service provider sector and is paid based on FSCO's fiscal year cycle that begins on April 1 and ends on March 31. The fee is due no later than March 31 and is calculated based on the data provided in the AIR for the prior calendar year.
 
The Annual Regulatory Fee is calculated based on the following formula:
 
A + B
 
"A" = $128 x the "Number of Locations" of the licensee.
 
"B" = $15 x the "Number of SABS Claimants" of the licensee. For this purpose:
 
"Number of Locations" is the maximum number of physical locations at which the licensee carried on business that gave rise to listed expenses in the prior calendar year (January 1 to December 31) during the period in which the service provider held a licence from FSCO.
 
"Number of SABS Claimants" is the total number of persons for which payment has been received for one or more listed expenses (calculated per accident) during the prior calendar year. A person may be counted more than once if they have been involved in multiple accidents.
 

Step 2 - General Information (Service Provider/Business)


The purpose of this section is to confirm the business information on file.

Please review the following. PLEASE NOTE: If any of the information is not up-to-date, you must:
 
  1. Withdraw this AIR using the Quit button below.
  2. Submit the appropriate supplemental applications using the left menu link “Request a Change”.
  3. Start your AIR again once those applications are approved by FSCO.
  • Licence Number
  • Licensed Business
  • Principal Representative for the Business
  • Business Ownership Type
  • This list contains the directors, officers and partners that FSCO currently has on file for your business:
  • This list contains the Registered Trade Names that FSCO currently has on file for your business:
  • Ontario mailing address for the business
Please respond to the following:
                  
  • Please select the response which applies to the business:
    • Not part of a franchise arrangement
    • Franchisee (Business has been granted a licence to do business under a franchisor’s trademark)
  • (If franchisee selected): Business was part of the following franchise as at December 31:
The Business has the following (primary) website used for marketing or advertising related to automobile accident claims:

The business has the following (primary) Twitter account used for marketing or advertising related to automobile accident claims:

The Business has the following (primary) LinkedIn account used for marketing or advertising related to automobile accident claims:
 

Step 3 - General Information (Principal Representative)


The purpose of this section is to confirm the principal representative information on file.

Please review and update if necessary.
 
  • Principal Representative Email Address
  • Principal Representative Phone Number
  • Principal Representative Fax Number
  • Principal Representative belongs to the following Regulatory Colleges (Regulated Health Professional governed by a College under the Regulated Health Professions Act, 1991 or the Ontario College of Social Workers and Social Service Workers under the Social Work and Social Service Work Act, 1998) as at December 31:

Step 4 - Membership Information


The purpose of this section is to collect marketplace information. Please respond to the following questions with information as at December 31. 
 
  • At December 31, did you, as principal representative, or the business have an active accreditation status from either of the following Health Care Accreditation Organizations:
  • CARF CANADA:
    • (y/n)
    • If so, please indicate expiry year.
  • ACCREDITATION CANADA:
    • (y/n)
    • If so, please indicate expiry year.
  • Was the business a member of a Preferred Provider Network (PPN) as at December 31? Please indicate with which insurers. (Button to read “add the PPN insurers”)
  • Please specify the purpose of the membership in the PPN.
 

Step 5 - General Business Information        


The purpose of this section is to collect marketplace information. To help you answer the business information questions please refer to the following terms:
 
"Listed Expenses" include: (a) any assessments, examinations, reports, forms or plans, that are specified for the purposes of section 49 of the Statutory Accident Benefits Schedule - Effective September 1 2010 (SABS) in the Superintendent's Health Claims for Auto Insurance (HCAI) Guideline; (b) a disability certificate referred to in paragraph 2 of section 66 of the SABS, if an invoice in respect of the certificate is submitted to HCAI instead of to an insurer; and (c) any goods and services specified for the purposes of section 49 of the SABS in the Superintendent's HCAI Guideline.
 
"Non-Regulated Health Professional" refers to an individual who provides one or more listed expenses whose profession is not subject to regulation under the Regulated Health Professions Act, 1991 or the Ontario College of Social Workers and Social Service Workers under the Social Workers and Social Service Workers Act, 1998.
 
"Number of Locations" is the maximum number of physical locations at which the licensee carried on business that gave rise to listed expenses in the prior calendar year (January 1 to December 31) during the period in which the service provider held a licence from FSCO.
 
"Number of SABS Claimants" is the total number of persons for which payment has been received for one or more listed expenses (calculated per accident) during the prior calendar year. A person may be counted more than once if they have been involved in multiple accidents.

"Regulated Health Professional" refers to a member of a profession governed by a College under the Regulated Health Professions Act, 1991, or by the Ontario College of Social Workers and Social Service Workers under the Social Work and Social Service Work Act, 1998.
 
  • During the reporting period, what were the business activities of your licensed HCAI locations? Please select all that apply.
    • Treatment Provider
    • Insurer Examinations (Section 44 of the SABS)
    • Assessment Centre (Other than Insurer Examinations)
    • Providing/Supplying Medical Equipment
    • Other Health Care services
  • For which insurance companies did your business perform Insurer Examinations?
  • During the reporting period, did any Regulated Health Professionals provide goods or services to SABS claimants on behalf of the business?
  • Total number of Regulated Health Professionals providing goods or services.
  • Select the types of goods and services provided by Regulated Health Professionals that were billable through an OCF-21 (Auto Insurance Standard Invoice) in HCAI.
  • During the reporting period, did any Non-Regulated Health Professionals provide goods or services to SABS claimants on behalf of the business?
  • Total number of Non-Regulated Health Professionals providing goods or services.
  • Select the types of goods and services provided by Non-Regulated Health Professionals that were billable through an OCF-21 in HCAI.
  • The answers to these questions will be used for calculating your Annual Regulatory Fee: Number of Locations?  Number of SABS Claimants?


Step 6 - Business Systems and Practices

 
The purpose of this section is to verify compliance with the Insurance Act and collect marketplace information. Please respond to the following:
 
  • Did the business have policies and procedures related to the billing and business practices of SABS claimants in place as at December 31?
  • When were these policies and procedures last reviewed?
  • How often does the business verify SABS claimant identity?
  • Which of these identification documents are reviewed: Select all that apply:
    • Driver’s Licence
    • Health Card
    • Other
  • What are the business’s standard practices for obtaining a claimant's signature on the OCF-18 (Treatment and Assessment Plan) and the OCF-23 (Treatment Confirmation Form)? Select all that apply:
    • Complete form, obtain signature, submit form.
    • Obtain signature, complete form, submit form.
    • Complete form, submit form, signature obtained at a later date.
    • Complete form, submit form, no signature obtained.
    • No SABS Claimants.
  • During the reporting period, did the business ensure that only Health Practitioners (i.e. chiropractor, dentist, registered nurse, occupational therapist, optometrist, physician or physiotherapist, psychologist, speech-language pathologist) signed part 4 of the OCF-18/23 forms?
  • During the reporting period did any of the following events occur? Please provide details.
    • Submission of duplicate versions of an OCF-18, OCF-23 or OCF-21 to HCAI.
    • Allowing a SABS claimant to sign an inaccurate or false or deceptive OCF-18 or OCF-23.
    • For the same or similar goods or services, did you charge SABS claimants a higher amount than other persons or entities who were not involved in a motor vehicle accident.
    • Charging an amount for goods and services to, or for the benefit of, a SABS claimant if the goods or services were not provided (this does not include any fees charged as a result of a cancelled or missed appointment).
    • Submission of invoices more frequently than permitted under the applicable guidelines.
    • Submission of invoices prior to insurer approval.

Step 7 - Billing Information and Practices   

 
The purpose of this section is to verify compliance with the Insurance Act and facilitate examination planning. Please provide the following information, ensuring that the given information is for the reporting period:
 
  • During the reporting period, did the business submit invoices through HCAI for listed expenses from more than one service location? 
  • During the reporting period, in what format were the business's billing records stored?
  • During the reporting period, did you, as the principal representative, ensure the paper and electronic records were secure and could not be falsified?
  • As at December 31, please provide the total number of people who submit invoices and/or treatment forms through HCAI.
  • Did you, as the principal representative, or the business, make use of the Monthly Financial Statement Reports provided in HCAI to reconcile billing?
  • Did you, as the principal representative, ensure that your business conducted periodic reviews of the forms, plans, invoices, documents and other information submitted to insurers regarding SABS, in order to ensure compliance with the Insurance Act and applicable Guidelines, and to ensure the reconciliation of its billings?
  • During the reporting period, did the business prepare annual financial statements?      
  • Select the type of financial statements prepared.
  • Enter the month and day of your business's fiscal year end.
  • During the reporting period, how often did you, as the principal representative, review your Rostered Health Professionals List in HCAI to ensure it was up to date? (“Rostered Health Professional” is a health professional on the roster of a facility registered with HCAI.)
  • Is your Rostered Health Professionals List in HCAI currently up to date?
  • Have your Rostered Health Professionals authorized the use of their signature on OCF-21 invoice forms by other individuals within the business? (Y/N)
  • If Y: Is this authorization documented, including an effective date? (Y/N)
  • During the reporting period, what percentage of the business’s patients were SABS claimants:
    • 0-20%
    • 21% to 50%
    • 51-70%
    • 71%-100%
  • Total dollar amount of OCF-21 billings to auto insurers under the licence for the reporting year:

Step 8 - Suitability

 

FSCO continuously assesses the suitability of licensed businesses to operate in Ontario. Suitability requirements refer both to businesses and their principal representative. As the principal representative, you are required to provide information about yourself and about the business.

 

Providing false, misleading or incomplete information in this AIR is an offence under the Insurance Act. Doing so may be sufficient grounds to suspend or revoke a licence, or result in prosecution or other regulatory penalties.
 
Offences under federal statutes such as the Criminal Code, the Controlled Drugs and Substances Act and its predecessor the Narcotic Control Act, the Food and Drugs Act, the Income Tax Act (Canada), the Immigration and Refugee Protection Act (Canada), the Competition Act, and the Copyright Act are criminal offences and must be disclosed.

If charges are pending or you have pleaded guilty or been found guilty of an offence under the above statutes, or any others, this information must be reported even if you were given an absolute or conditional discharge.
 
You do not have to disclose any offence for which a record suspension (formerly known as a pardon) has been granted under the Criminal Records Act (Canada) and has not been revoked.
 
Record suspensions are not automatically granted merely because of the passage of time. A record suspension is not automatically granted because you applied for one. Written confirmation from the National Parole Board of your granted record suspension is the only way to ensure a record suspension has been granted.

An absolute or conditional discharge is not a record suspension and, therefore, must be reported. You do not have to disclose convictions under either the Youth Criminal Justice Act or its predecessors, the Young Offenders Act or the Juvenile Delinquents Act.
 
Charges and convictions under provincial statutes must also be disclosed. Such statutes include the Independent Health Facilities Act, the Regulated Health Professions Act, 1991, the Provincial Offences Act, the Insurance Act, the Mortgage Brokerages, Lenders and Administrators Act, 2006, the Registered Insurance Brokers Act, and the Human Rights Code, or their equivalent in other provinces.

You do not have to disclose findings of guilt for traffic infractions such as speeding or parking violations.
 
If you answer "Yes" to any question in this section, please provide a full explanation in your own words in the window that will open. Please retain all relevant documentation for future reference.
 
  • During the reporting period, did you or the business have a licence or a registration suspended under any regulatory regime in Ontario or elsewhere? Provide the details regarding the suspension(s)?
  • During the reporting period, did you or the business have a licence or a registration refused under any regulatory regime in Ontario or elsewhere? Provide the details regarding the refusal.
  • During the reporting period, did you or the business have a licence or a registration revoked under any regulatory regime in Ontario or elsewhere? Provide the details regarding the revocation?
  • During the reporting period, did you or the business declare bankruptcy, or make a voluntary assignment in bankruptcy; or are you or the business presently party to bankruptcy proceedings?
  • During the reporting period, did you or the business plead guilty or were found to be guilty of an offence under any law of any province, state or country; or are you or the business currently the subject of charges?
  • During the reporting period, were you or the business successfully sued in a lawsuit based, in whole or part, on fraud, theft, deceit, misrepresentation or forgery; or based on professional negligence?
  • During the reporting period, was a complaint made against you to any regulatory body in a Canadian jurisdiction that was based, in whole or part, on fraud, theft, deceit, misrepresentation, forgery or similar conduct; or based in whole or in part, on professional negligence or misconduct? Provide the details regarding the complaint(s).