FSCO warns Service Providers to improve compliance rate

Service Providers eNewsletter – Issue #19


Enforcement targeting sector’s “unacceptable” 15% compliance level


Findings from the Financial Services Commission of Ontario’s (FSCO’s) 2015/16 on-site examinations show a 15 per cent full compliance rate for the health service provider sector, which FSCO considers to be unacceptable. By comparison, the other regulated sectors overseen by FSCO generally maintain over 90 per cent compliance levels.

Wherever FSCO finds a contravention of the Insurance Act and its regulations during its on-site examinations, the service provider has 90 calendar days to work with a FSCO senior compliance officer to implement any missing requirements. If the service provider fails to do so, FSCO may take enforcement action, which could include:


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

YOU SHOULD KNOW: Before obtaining signatures on an OCF-18, OCF-21 or OCF-23, the entire form must be completed and reviewed by the health care practitioner and, if applicable, the regulated health professional and the claimant.


Enforcement update

FSCO is revoking and suspending the licences of service providers who have failed to file the annual information return (AIR). For more information on recent enforcement action in the health service provider sector, please visit FSCO’s website.


Non-compliance trends

Since the implementation of the health service provider licensing regime on December 1, 2014, three non-compliance issues remain the most common:


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

Many service providers are also failing to keep their HCAI roster up to date. As a reminder, you must remove health professionals from your roster when they are no longer employed with you. 


YOU SHOULD KNOW: Facilities must keep a copy of the OCF-21 on file. The copy can be the original paper version, which includes the original authorized signature of the regulated health professional providing treatment, or an electronic copy saved in pdf format, which includes the original authorized signature of the regulated health professional. The regulated health professional can also designate an “Authorized Signatory” to sign the OCF-21 on their behalf provided their consent has been given.


Complaint protocol

If you have a complaint about the conduct of an insurer, or if you have a complaint about another service provider regarding business/billing practices, you should complete the appropriate complaint form and submit it to FSCO. Both complaint forms can be found on FSCO’s website.


You should provide a clear, written description of the allegation and any supporting documents – including copies of detailed, date-stamped notes and/or correspondence and phone conversations – to help validate your complaint. Phone conversations, or other such evidence, can be submitted to FSCO translated to text or on a CD-ROM.

For more detailed information on the complaint process and appropriate forms, please visit FSCO’s website.


Assessment of Attendant Care Needs (Form 1) HCAI pilot project


On October 1, 2016, FSCO and HCAI introduced a voluntary one-year pilot project that will enable service providers enrolled with HCAI to submit the Assessment of Attendant Care Needs (Form 1) to insurers electronically. Service providers who do not enroll with the pilot project will continue to submit the Form 1 to insurers directly.


FSCO expects that following the pilot project, it may become mandatory for Form 1 to be submitted electronically through the HCAI system.

For more information, visit FSCO’s website and watch HCAI’s video [New Window].


Where to go for more information


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