Rehab Providers: Access to Care is at Stake

Rehab Providers - email AutoInsurance@ontario.ca by July 12, 2021 to have your voice heard! The Ontario government is requesting consultation from stakeholders in order to determine how to reduce the incidence of auto insurance fraud and abuse in its “Abuse and Fraud Consultation Paper”.

The Ministry of Finance admits that there is no accurate quantification of auto insurance fraud and abuse in the system, yet the very fact that they are engaged in a process of soliciting public feedback about proposed reforms demonstrates that they consider this issue to be an ongoing and significant problem in the system. Without a doubt, they are reacting to complaints by auto insurance companies across the Province that fraud and abuse remains rampant within the system. It is important that care providers make their voice heard so that “insurance fraud and abuse” is not defined so widely that it is used as a basis for insurance companies to deny funding to legitimate service providers and drive them out of business.

The Proposed “Anti-Fraud” Reforms

Some of the proposed reforms contemplated by the government include establishing a legislative definition of insurance fraud and abuse, requiring the co-operation of insured persons with investigations about insurance fraud and abuse, enhancing the use of preferred provider networks, and allowing insurers to exclude coverage for services provided by certain vendors.

While reducing fraud, abuse and unnecessary costs in the system is a laudable goal, there is a real risk that the government may interfere with the ability of insured persons to access treatment from legitimate providers in its zeal to drive bad actors out of the system. This is particularly true if a broad definition of “insurance fraud and abuse” is incorporated into legislation. The reforms proposed by the Ministry have the potential to interfere with the therapeutic relationship between service providers and their patients, as well as to significantly increase compliance and investigative costs for service providers.

These proposals arrive against a background of a decade long crackdown against fraud and abuse in the auto insurance system, in which it has become increasingly difficult and costly for rehabilitation providers to offer services to the public which are claimed through auto insurance companies. Some auto insurance companies are already taking aggressive action on their own to exclude coverage for service providers which they consider to be suspect, with little oversight from regulators. The proposed reforms contemplated by the Ministry of Finance would only serve to entrench a system which is already tilted in favour of enhancing the bottom lines of insurance companies and against the ability of patients to access rehabilitation services which they require to recover from injuries suffered in automobile accidents.

It's Time to Act

Rehabilitation providers must seize this opportunity to make their voices heard during the consultation process established by the Ministry of Finance, before the government acts to impose further barriers to providing effective patient care at the behest of the insurance industry. Service providers need to ensure that any reforms adopted by the government in the name of curbing fraud and abuse do not become a basis for undermining the ability of rehabilitation providers to offer services which are in the best interests of their patients, rather than being dictated by the mandates of cost control. Many care providers under Ontario’s auto insurance system have already found it difficult to maintain their financial viability with ongoing cutbacks in available coverage and an increased regulatory burden even before the COVID-19 pandemic interrupted the provision of many services to the public.

The time to speak up is now, before it’s too late. Learn more here.