Archived News Releases
For immediate release
May 12, 2011 1:30 P.M.
Toronto – Pioneer Rehabilitation Clinic Inc. pleaded guilty to knowingly making false or misleading statements to an insurer in order to obtain payment for goods and services provided to an insured in the Ontario Court of Justice in Toronto on May 12, 2011.
The court ordered a conviction and a $50,000 fine. Pioneer must also pay a $12,500 surcharge to the Victims' Justice Fund.
In August 2010, the Financial Services Commission of Ontario (FSCO) laid charges against Pioneer. Following an investigation, FSCO found that Pioneer had submitted false treatment plans and false invoices, in some cases to get paid for treatment that was never provided.
FSCO investigates allegations of misconduct, unfair practices and non-compliance with legislation or regulations in its regulated sectors. If warranted, FSCO takes enforcement action, such as initiating a prosecution.
FSCO is an agency of the Ministry of Finance established under the Financial Services Commission of Ontario Act, 1997. It regulates insurance, pension plans, loan and trust companies, credit unions and caisses populaires, co-operative corporations and mortgage brokerages and administrators in Ontario.
- "Abuses of the auto insurance system by unscrupulous participants will not be tolerated. FSCO will continue to prosecute these abuses." – Philip Howell, CEO and Superintendent of FSCO
- Insurers have rights and responsibilities under the Statutory Accident Benefits Schedule (SABS) to challenge questionable or abusive claims, including verifying invoices and expenses.
- Ontario is establishing an auto insurance anti-fraud taskforce to determine the scope of auto insurance fraud in Ontario and make recommendations on detection, investigation, enforcement and consumer education.
- As of February 1, 2011, all Ontario health care facilities or providers were required to transmit auto insurance claim forms to insurers through Health Claims for Auto Insurance (HCAI). This database will help to detect auto insurance abuses.
- Ontario auto insurers will be required to annually attest that their companies have established effective compliance controls to satisfy the rules that protect the rights of policyholders and accident victims.