The Financial Services Commission of Ontario’s (FSCO’s) issued a stern warning to Health Service Providers, last week, calling compliance levels in the sector “unacceptable”, and threatening to take punitive actions against offending organizations. Such actions could include monetary penalties, suspension, or license revocation.
In its newsletter to the sector, FSCO said its “Findings from the Financial Services Commission of Ontario’s (FSCO’s) 2015/16 on-site examinations show a 15 per cent full compliance rate for the health service provider sector, which FSCO considers to be unacceptable.” By comparison, other sectors regulated by FSCO maintain over 90 per cent compliance levels.
Over the past year, FSCO has completed more than 551 on-site examinations of licensed service providers, of which 83 were found to be in full compliance. The most common deficiencies are found in three areas:
Rate of occurrence
|Patient ID not verified||27%||53%||37%|
|No policies and procedures in place||28%||32%||35%|
|OCF forms left unsigned||25%||16%||32%|
FSCO has also reproached Service Providers on the completion, signing and retention of OCF forms. It noted that the forms (OCF-18 and OCF-23) must be “completed and reviewed by the health care practitioner and, if applicable, the regulated health professional and the claimant”, before the relevant signatures are obtained.
Health care Facilities must keep a copy of the completed OCF file. The copy can be the original paper version or a PDF version that includes all of the required signatures. Copies stored on HCAI or PMS are not adequate, unless it meets the tests for completeness and signatures.
Non-compliant Health Providers are given 90 days to bring their organization into compliance. Failure to do so could lead to further action by FSCO, including:
- licence suspension;
- licence revocation; and/or
- Administrative monetary penalties.
Although FSCO is more focused on education and guidance at this stage, the regulator warns that it will consider more punitive measures.
Increased regulatory activities planned
FSCO plans a more aggressive monitoring program for 2016/17 to address the low level of compliance. The regulator also hinted of possible increase in fees to the sector as a way of recovering the costs of additional compliance programs. FSCO has also warned that it is revoking and suspending the licenses of service providers who have failed to file the annual information return (AIR).
Regulation of health clinics who wish to bill auto insurers directly for certain expenses under the Statutory Accident Benefits Schedule (SABS) took effect in December 2014. Today, more than 5,000 service providers are registered with FSCO.