As many already know, the Financial Services Commission of Ontario (FSCO) has been conducting onsite examinations since December 2014. This is to ensure that service providers are complying with the Insurance Act and regulations. FSCO selects service providers for examinations not only randomly, but also based on the Annual Information Return (AIR) – focusing on those who are considered “higher-risk service providers.”
FSCO also uses examinations as an educational tool to help clinics ensure their daily procedures are performed in accordance with the regulations.
We want to remind our customers about the importance of having the OCF documents (don’t forget about OCF 21 invoices) signed when working with MVA patients. A few of our customers have recently been examined by a FSCO senior compliance officer, one of the things they were looking for as they reviewed the OCFs are the signatures. The How to Add a Signature to Staff Member article will help you upload electronic signatures into Universal Office.
FSCO has published results from 2016-2017 onsite examinations with the summary of violations, possible resulting enforcements and a list of procedures that take place during examinations.
Summary of Most Common Contraventions and Applicable Enforcements:
- Contravention: Missing signatures of healthcare providers and/or patients on Ontario Claim Forms (OCF).
Enforcement: May range from an administrative monetary penalty (AMP) to the suspension or revocation of a license. - Contravention: Skipping verification of patient ID.
Enforcement: FSCO may consider a general AMP of up to $25,000. - Contravention: Business changes are not reported to FSCO in a timely manner.
Enforcement: FSCO may consider a summary AMP of $250. - Contravention: Outdated or inaccurate list of healthcare professionals in HCAI.
Enforcement: FSCO may consider a general AMP of up to $25,000. However, if outdated or inaccurate roster was used to falsely bill under a regulated health professional’s name, FSCO may consider a general AMP of up to $200,000 for businesses and a maximum of $100,000 for individuals and/or the suspension or revocation of a license. - Contravention: Absence of policies and procedures in place for billing and business practices.
Enforcement: FSCO may consider a general AMP of up to $25,000.
What to Expect from FSCO Examination:
- Accuracy and completeness of information gathered from the Annual Information Return will be subject to verification.
- Assessing whether the physical space is suitable for the offered services.
- Review of Statutory Accident Benefits Schedule (SABS) files.
- Staff interviews to assess employee understanding of stated procedures.
- Analysis of the referral process and any relationships between other parties to assess any direct or indirect referrals.
- Analysis of patient intake and discharge processes for possible contraventions.
- Canvassing of related businesses nearby to validate any referral relationships.
- Reconciliation of the hourly rates set out in the Professional Services Guideline with the service provider’s billing.
Keep in mind, the procedures performed by FSCO senior compliance officers during the examinations are not limited to the above list.
You can find regulations for service providers made under the Insurance Act on the FSCO website. If your facility has been selected for examination, the FSCO examinations of licensed service providers article will help you prepare for it.
You will also want to check out the article we published in 2015, titled An Inside Look at FSCO Inspections of Licensed Service Providers.
What do you do to make sure your practice management policies and procedures comply with the Insurance Act and regulations?
