FSRA tackles health service provider compliance

The Financial Services Regulatory Authority of Ontario (FSRA) has set its sights on the health service provider industry, releasing a two-year supervision plan that focuses on higher-risk service providers.

FSRA’s two-year supervision plan for the years 2022 through 2024 aims to support fair and reasonable auto insurance rates for customers and promote high standards of business conduct among health service providers by ensuring that health service providers comply with the law and licensing requirements. It defines health service providers as those who help people who have been injured in an auto accident.

According to the supervision plan’s focus areas, FSRA will be selecting practices among the following health service providers for examination:

• Those who conduct examinations that help insurers determine if a policyholder is entitled to a benefit. As controllers of the confidential medical information of many Ontario consumers, these service providers are relied upon by insurers to help adjudicate benefits, significantly impacting consumers’ benefit limits.
• Those who have never been examined by FSRA. FSRA will be conducting a compliance review that focuses on common areas of non-compliance among service providers, mainly among those it has not yet examined.
• Those who have a sanctioned practitioner listed on their health claims for auto insurance (HCAI) roster. FSRA considers sanctioned practitioners a potential risk to the industry where benefits end up paying for services provided by an unauthorized practitioner.

"By focusing on service providers who are higher risk, FSRA promotes high standards of business conduct and protects consumers' rights and interests," said senior manager for market conduct Beata Morris.

Morris said that FSRA’s oversight and supervisory initiatives were not only designed to foster compliance on the part of health service providers but awareness in the sector as well. "That's why, as part of its supervisory activities, FSRA will be doing more to help service providers understand what they need to do to meet their obligations and treat consumers fairly,” she said.

FSRA expects all health service providers to review the two-year supervision plan and has released relevant publications to guide them through their compliance with the law and licensing requirements, such as its online quick guide to compliance.