FSRA Releases 2024-2026 Health Service Provider Supervision Plan
TORONTO, Jan. 23, 2025 /CNW/ - With the release of its third Health Service Provider Supervision Plan, Ontario's financial services regulator, FSRA, is taking decisive action to ensure fair outcomes for motor vehicle accident victims.
When a person is injured in a motor vehicle accident and seeks medical treatment from a licensed health service provider, it is essential that their benefit dollars are used effectively towards their care and recovery.
FSRA's 2024-2026 efforts focus on fostering greater compliance in the sector, ensuring health services providers bill automobile insurers appropriately for benefits claimed under the Statutory Accident Benefits Schedule (a regulation under Ontario's Insurance Act).
FSRA licenses health service providers, enabling them to receive direct payment from auto insurers to cover health and rehabilitative expenses of Ontarians injured in motor vehicle accidents. Direct billing reduces the need for consumers to pay out of pocket and wait for reimbursement. Requirements exist for policies, procedures, and best practice standards to avoid the submission of false or misleading information to insurers to address the risk of incorrect or inconsistent billing practices or fraud.
"FSRA is committed to protecting the rights of motor vehicle accident victims and ensuring health service providers understand and meet their responsibilities," said Huston Loke, Executive Vice President, Market Conduct, at FSRA. "This new supervision plan for 2024-2026 targets specific areas to support a fair, transparent, and compliant health service provider sector."
During the past two fiscal years, FSRA conducted three supervision initiatives and identified a high level of non-compliance by health service providers. This conduct persisted despite dedicated efforts to raise awareness of regulatory obligations within the sector.
FSRA's third Supervision Plan focuses on:
- Verifying compliance among top-billing health service providers in the Health Claims for Auto Insurance (HCAI) system who have never been reviewed by FSRA.
- Understanding the management of preferred provider network (PPN) agreements by insurers and health service providers to ensure fair treatment of customers and compliance with regulatory requirements.
- Identifying health service providers with sanctioned practitioners on their HCAI roster and conducting reviews for unauthorized activity in the HCAI system.
In addition to focusing on supervision, FSRA is reviewing the Health Service Provider Framework in support of the Ontario Government's commitments to improve the auto insurance system.
2024-2026 supervision activities have already begun. FSRA expects health service providers to review the Supervision Plan and other relevant publications to ensure awareness and compliance with regulatory requirements.
Learn More
FSRA continues to work on behalf of all stakeholders, including consumers, to ensure financial safety, fairness, and choice for everyone. Learn more at www.fsrao.ca.
Links
- 2024-2026 Health Service Provider Supervision Plan
- 2022-2024 Health Service Provider Market Conduct Compliance Report
- Health Service Provider Quick Guide to Compliance
- Health Service Provider Webinar
FOR MEDIA INQUIRIES:
Russ Courtney
Sr. Manager, Media Relations
Financial Services Regulatory Authority
C: 437-225-8551
Email: [email protected]
SOURCE Financial Services Regulatory Authority of Ontario
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