Ensuring Fair and Transparent Billing Practices
Under Ontario’s Statutory Accident Benefits Schedule (SABS), health service providers are allowed to bill automobile insurers directly for medical and rehabilitative expenses incurred by accident victims. While this system helps provide necessary care, it also opens the door to fraudulent or inconsistent billing practices. To tackle this, FSRA is implementing stricter oversight measures that ensure billing practices are transparent, consistent, and beneficial to accident victims.
Key Areas of Focus in the New Plan
FSRA’s new supervision plan outlines three key areas of focus:
Top-Billing Health Service Providers: FSRA plans to review compliance among high-billing providers listed in the Health Claims for Auto Insurance (HCAI) system, particularly those that haven’t been previously evaluated by the regulator. This will ensure that top providers follow the required standards for billing.
Preferred Provider Network Agreements: FSRA will examine how insurers and health service providers manage preferred provider network (PPN) agreements. This review aims to ensure that these agreements are fair and that consumers are treated consistently across the system.
Sanctioned Practitioners: FSRA will also monitor health service providers whose HCAI rosters include sanctioned practitioners, aiming to identify and address unauthorized activities that could compromise the claims process.
A Step Toward Better Transparency and Consumer Protection
The new plan comes after FSRA’s review of the sector over the past two years, where it found significant non-compliance among health service providers. In addition to strengthening oversight, FSRA is also reviewing the broader Health Service Provider Framework as part of Ontario’s initiative to improve the auto insurance system. This comprehensive approach is designed to enhance both transparency and accountability in the sector.
FSRA’s Next Steps
FSRA has already begun implementing the 2024-2026 plan and is encouraging health service providers to familiarize themselves with the new guidelines and resources. By fostering better compliance, FSRA aims to ensure that Ontario’s auto insurance system is fair, transparent, and effective for all involved.
For consumers, these changes will help ensure that accident benefits are used for their intended purpose: to support patient care and recovery. As FSRA continues to monitor and enforce new regulations, the overall goal is to create a more transparent and reliable system for Ontario’s accident victims.
