In December 2014, the Financial Services Commission of Ontario (FSCO) began on-site examinations of licensed service providers. FSCO conducts these examinations throughout the year to ensure that licensed service providers are in compliance with the Insurance Act and regulations.
FSCO is also using the examinations as an educational tool to help service providers establish practices and procedures in their day-to-day operations that will facilitate compliance in the future.
FSCO senior compliance officers (SCOs) will visit approximately 200 places of business by the end of March. FSCO is selecting service providers for examination at random and using risk factors identified during the licensing process.
"There is nothing to be nervous about. A list of required documents I received a week prior to upcoming date helped me to be well prepared. The examiners were very helpful throughout the entire process." – Farida Kasimova, Health-Pro Wellness
If your business is selected for examination, a SCO will contact you. The SCO will work with you to select a suitable date for the examination.
The examination usually takes about one day (eight business hours).
Although there is no need to "close shop" during the examination, you may want to keep your patient schedule light in order to respond to questions from the SCO.
Preparing for the on-site examination
If your business is selected for examination, you can prepare by readying the following materials:
- Legal entity information such as articles of incorporation and master business licence (where applicable).
- Information on staffing such as health discipline practiced, registration/certification numbers, start and end dates.
- Financial statements for past two years.
- Recent HCAI billing activities, for example, reports, statements, summaries.
- Policies and procedures regarding billing practices for MVA patients.
- Completed OCF forms 18 & 23, 21. (The SCO will review to ensure the forms are completed in compliance with the regulations. Personal information will not be collected and need not be disclosed for the purposes of the review.)
Your Principal Representative or other staff member should also prepare to demonstrate how your business accesses and undertakes billing procedures through HCAI.
A word about confidentiality
FSCO’s on-site examinations of service providers are about ensuring compliance with billing and business practices only; there will be no gathering or recording of medical or personal information of patients or clinical notes. As with any regulatory examination, SCOs are bound by confidentiality rules.
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