FSCO issues administrative monetary penalties in service provider sector

Service Providers eNewsletter – Issue #18

Recent enforcement action

On May 16, 2016, FSCO imposed administrative monetary penalties (AMPs) and ordered the first revocation of a service provider licence since the implementation of the licensing regime on December 1, 2014.

A $21,985.17 AMP was imposed for fraudulent activity, as identified through on-site examinations and investigations, for submitting false health care expenses for reimbursement. An additional $4,000 AMP was imposed on the principal representative for non-compliance, including failure to respond to requests by the Superintendent and failure to properly supervise.

For more information on enforcement action in the service provider sector, please visit the Enforcement Online section of the FSCO website.

FSCO moves to enforcement approach for on-site examinations

Since December 1, 2014, FSCO has conducted 677 on-site examinations. The number of licensees examined represents more than 15 per cent of all licensees.

As a result of these on-site examinations, FSCO identified the following common issues of non-compliance:

patient identification is not verified for every claimant;
policies and procedures are not established and implemented; and
OCFs are unsigned by either the claimant, the service provider, or in some cases, both.

If contraventions of the Insurance Act and its regulations are found, FSCO will make required recommendations, which the service provider must implement within 90 calendar days. FSCO may schedule a follow-up visit after the 90-day period to ensure the recommendations have been implemented and that there are no ongoing contraventions.

If the service provider has not implemented FSCO’s recommendations or is otherwise still non-compliant, then FSCO will take enforcement action. Enforcement action may include:

licence suspension;
licence revocation; and/or
administrative monetary penalties.

FSCO expects that licensed service providers understand and comply with the standards of business practices prescribed in Regulation 90/14 under the Insurance Act. FSCO encourages licenced service providers to visit the service provider section of the FSCO website to learn more about their legal obligations.

Annual information return

Licensed service providers were required to file the Annual Information Return (AIR) by March 31, 2016.

If your AIR is still outstanding, you are required to file it immediately in order to avoid being subject to enforcement action.

Increased regulatory activities planned for 2016/17

To date, only 15 per cent of licensed health service providers are fully compliant with the law, which is a serious concern to FSCO. Regulatory compliance rates for other financial services sectors FSCO regulates exceed 90 per cent.

FSCO is currently planning its 2016/2017 regulatory activities to address the low level of compliance amongst health service providers and develop a responsive enforcement strategy. FSCO is also undertaking a review of fees as part of its planning. Generally speaking, a higher level of compliance in a sector leads to reduced regulatory activities, which impacts future regulatory fees.

Keep your business information up-to-date

DID YOU KNOW?: Health care providers who leave your facility must be deactivated in HCAI by adding an end-date. Instructions on how to deactivate a provider or user can be found on the HCAI website

Service providers must report any change in business information to FSCO within five business days. This includes changes to your mailing address, facility address, business name, telephone number, email address, principal representative and/or directors/officers.

Earlier in 2016, FSCO made improvements to the Public Registry of Licensed Service Providers. Individuals can now search for a licensed service provider by facility address, city, postal code and principal representative. The registry is a tool increasingly used by consumers to find licensed service providers, making it all the more important to keep your business information up-to-date.

Auto insurance reforms – updated forms

On June 1, 2016, changes to statutory accident benefits took effect. You can review the updated forms on the Auto Insurance Claims Forms section of the FSCO website.